Text Only Version - Privacy Policy & P3P

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Dear Oregonian:

If you need assistance with a federal agency, please fill out this form and submit it with any necessary documentation and background information. My office will contact you as soon as we receive the form. In some cases, my office may ask you to fill out a Privacy Release Act form, which when signed and returned to us, will prove to federal agencies that we are working on your behalf and with your permission.

Please submit the following form online, or mail, fax or e-mail a completed casework form to Senator Wyden's Portland office:

Senator Ron Wyden
700 NE Multnomah, Suite 450
Portland, OR 97232
FAX: 503-326-7528
E-MAIL: caseworker@wyden.senate.gov

 

Please enter name and address of constituent contacting office. Fields marked with an * are required.

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First Name, Middle Init. *
Last Name, Suffix *
Street Address *
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Social Security #, Claim # * (Claim)
Date of Birth *

If case is about another Oregon constituent, please fill out that person's information. Fields marked with an * are required.
 

Prefix *

 (Ex: Mr. and Mrs.)

First Name, Middle Init.*
Last Name, Suffix *
Street Address *
Street Address  
City, State *  
Zip *
Phone   (Home) (Work) 
Social Security #, Claim # * (Claim)
Date of Birth *

 
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Please write your message. (fewer than 3,400 characters)

Dear Senator Wyden,