Request Assistance with a Federal Agency

In most cases, Federal law requires us to have a signed authorization from you before we can discuss your case with the agency involved. Please download, fill out and sign our Case Information and Privacy Release Form. You may use the form below to initiate a review of your request, but we may require that you complete the Case Information and Privacy Release Form prior to taking action on your request.

Fields marked with an * are required.

Prefix  
First Name *  
Last Name *  
Suffix  
Street Address *  
Street Address 2    
City *  
State *  
Zip *  
      NOTE to service members who are California residents:
please provide us with your permanent California address, not your temporary out-of-state address.
Daytime Phone*    
Home Phone    
Work Phone    
Email *  
       
Which Federal Agency or Issue do you need assistance with? *  

 
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