Help With a Federal Agency

If you can't get an answer from a federal agency in a timely fashion, or if you feel you have been treated unfairly, my office may be able to help resolve a problem or get you the information you need. While we cannot guarantee you a favorable outcome, we will do our best to help you receive a fair and timely response to your problem.

Residents of my district can contact me for assistance in dealing with Federal agencies. In order to better serve you, this form will generate a printable page that you should sign and mail to my office.

Please include all pertinent information and claim numbers in your correspondence—such as:

  • Your Social Security number for a case involving Social Security;
  • VA claim number for a case with Department of Veterans Affairs;
  • Taxpayer identification number (Social Security number, if individual) for an Internal Revenue Service problem, etc.;
  • Your address, home phone number and daytime phone number (if different than home) so that we can obtain any additional information from you that might be necessary;
  • Copies of any related documents or correspondence that you may have from the agency involved;

Please Note:

The Privacy Act of 1974 (5 U.S.C. § 552a) requires that Members of Congress or their staff have written authorization before they can obtain information about an individual's case.
We must have your signature to proceed with this type of request.

* indicates required field.

Your Information

Agency Involved:*
Case Details

Print This Form

Use the Generate Request button to produce the document to authorize my office to help you. Then sign it and mail it to the address shown on the document. Please include any other documents or material that you think would help my office help you.

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    Label
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    Value

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    repName John Smith  
    helpWithFedAgencyAddress Haverhill District Office
    1234 S. Courthouse
    Haverhill, CA 35602
     
    district 21st District of California  
    academyUSCitizenDate July 1, 2012  
    academyAgeDate July 1, 2012  
    academyApplicationDueDate October 20, 2012  
    repStateABBR AZ  
    repDistrict 1  
    repState Arizona  
    repDistrictText 1st  
    repPhoto  
    SponsoredBills Sponsored Bills  
    CoSponsoredBills Co-Sponsored Bills  
         
         
         
         
         
  • Office Locations

    Office Name Location Image Map URL
    Washington DC Washington, DC Office
    2252 Rayburn HOB
    Washington, DC 20515
    Phone: (202) 225-4572
    Washington https://goo.gl/maps/tFWeE1YKJLw
    District Office District Office
    316 N Milwaukee St STE 406
    Milwaukee, WI 53202
    Phone: (414) 297-1140
    Fax: (414) 297-1086
    District https://goo.gl/maps/5xdmwdepKAG2