Personal Information
Salutation Ms., Mr., Dr., etc.
First Name
Last Name
Both your first and last name are required
Mailing Address
Address Continued
City
Primary Phone Number A primary phone number is required.
Secondary Phone Number
E-Mail Address An e-mail address is required.
Social Security Number NOTE: Your Social Security Number is NOT sent to our office; it is required for the privacy release form to print out on the next page.
Details for Assistance with a Federal Agency
Agency Involved
Please Choose
Bureau of Indian Affairs
Bureau of Prisons
Center for Medicare & Medicaid Services
Centers for Disease Control & Prevention
Comptroller of the Currency
Department of Agriculture
Department of Commerce
Department of Defense
Department of Education
Department of Energy
Department of Health & Human Services
Department of Homeland Security
Department of Housing & Urban Development
Department of Justice
Department of State
Department of the Interior
Department of the Treasury
Department of Veterans Affairs
Drug Enforcement Agency
Equal Employment Opportunity Commission
Fannie Mae
Federal Aviation Administration
Federal Bureau of Investigation
Federal Communications Commission
Federal Deposit Insurance Corporation
Federal Emergency Management Agency
Food & Drug Administration
Freddie Mac
Indian Health Service
Internal Revenue Service
National Guard Bureau
National Park Service
Occupational Safety & Health Administration
Office of Personnel Management
Securities & Exchange Commission
Selective Service System
Small Business Administration
Social Security Administration
Transportation Security Administration
U.S Citizenship & Immigration Service
U.S. Air Force
U.S. Army
U.S. Census Bureau
U.S. Coast Guard
U.S. Customs & Border Protection
U.S. Fish & Wildlife Service
U.S. Forest Service
U.S. Immigration & Customs Enforcement
U.S. Marine Corps
U.S. Merchant Marines
U.S. Navy
U.S. Patent & Trademark Office
U.S. Postal Service
Need help selecting the right federal agency? Please call 612-522-1212 for assistance.
Other Agency (if not listed above)
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Please state how you would like Congressman Ellison and his staff to help you
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