Assistance With a Federal Agency

Residents of the 18th Congressional District of Florida can contact me for assistance in dealing with federal agencies. In order to better serve you, this form will allow you to go to a printable page that should be mailed to the office for processing.

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 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 a casework inquiry.

 

Casework Authorization Form

In order to proceed with the casework inquiry, you must include your signature in the first paragraph below.

In accordance with the Privacy Act of 1974 (5 U.S.C. § 552a), I give Congresswoman Ileana Ros-Lehtinen authority to act on my behalf.

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Date of Birth (mm/dd/yyyy)
Social Security Number 
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Nature of Problem

 

Print This Form

You can print and sign this form after you click the Generate Form button. The address information is located on this page and also on the print preview page.

  

 

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