There may be occasions when you will need assistance in dealing with a federal agency and my office is here to help you. Residents of the 1st Congressional District of Nevada may contact me for assistance in dealing with federal agencies. In order to better serve you, this form will generate a printable page that you must sign and mail to my Las Vegas 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 this form with your signature to proceed with this type of request.

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Authorization Form

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

Today's Date
Full Name
Agency Involved
Branch of Service (If Applicable)
Military Rank (If Applicable)
Agency case number(s) (if there is no case number, indicate "None")
Date of Birth
Social Security Number
Street Address
City, State, Zip Code	,
Telephone No.
Email
Nature of Problem

 

Print This Form

Use the Generate Request button to produce the 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.