Casework Form

Federal Agencies—Getting Help

Residents of the 4th Congressional District of California can contact me for assistance in dealing with Federal agencies. In order to better serve you, this form will generate a printable page that you should sign and mail to my office.

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 (5 U.S.C. § 552a) 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 this type of request.

Authorization Form

In accordance with the Privacy Act of 1974, I give Congressman Tom McClintock authority to act on my behalf.

Name
Agency Involved
Agency case number(s) (if there is no case number, indicate "None")
Date of Birth
Social Security or Alien Registration Number
Street Address
City, State, Zip Code	,
Telephone No.
Work Phone
Cell
Fax
Email
Have you contacted another Congressional office regarding this matter?	Yes No

If "yes" to the above question, which office and when?

Nature of Problem

Print and Sign

Click on the "Generate Authorization" button above to produce the printable document to authorize my office to help you. Then sign it and mail it to the address shown on the document. Please include any other documents or material that you think would help my office help you.

PDF Version of the Authorization Form