Brooklyn:

If you need assistance with dealing with a federal agency, my staff and I may be able to help.  Please fill out the form below and then click "submit" to let me know what help you need.  If you need urgent assistance please call my office at 718-630-5277.

 

The Privacy Act of 1974 requires that Members of Congress and their staffs have written authorization from a constituent before we are able to access information on your case.  For that reason, in order for me and my staff to assist you this form will automatically create a Privacy Act Release Form which you will need to print out, sign, and send to my district office.  

 

Please fill out ALL required fields on the form which are indicated by an asterisk (*).  Fax or mail the subsequent form to my Staten Island Office at:

 

Fax:  (718) 630-5277

 

8505 4th Avenue, Brooklyn, NY 11209

 

General Assistance Form:

Today's Date *
Social Security Number *
Your Name*
Address *
City *
State*
Zip Code *
Daytime Phone Number *
Cell Phone Number
Date of Birth *
Federal Agency Involved *

  Description of Your Problem*:Please provide as much detail as possible


  

For more information on dealing with federal agencies please visit my Dealing with Federal Agencies and Programs page