Constituent Service Request Form - Printable

Privacy Act Statement

Under the Privacy Act of 1974, we must have formal authorization from you before seeking disclosure of your records. The authorization must be signed by the person whose case is in question.

In accordance with the Privacy Act of 1974 (5 USC 552), I hereby authorize Representative Trent Franks and his designated staff to seek disclosure of all records relevant to my case from the federal agency involved.

Signature:

Date: