Privacy Release Forms

Staff members in my district offices will make every effort to assist you in obtaining timely and accurate information from federal agencies.

According to the Privacy Act of 1974, you must give me written authorization to assist you with your case. Please fill out and send a signed copy of the appropriate Privacy Release form to my Rockville Office. You can find the forms at the red buttons on the top left corner of this page. This release form gives my staff your permission to discuss your case with the appropriate federal agency.

A letter explaining your problem or request is helpful for my staff to gain an understanding of your particular issue; supporting material offers a more complete picture of your situation and can be useful in providing relevant background information.

Once these documents are received by my staff, we will take the appropriate action on your behalf. A member of my staff will contact you if more information is needed or to let you know the steps that have been taken on your behalf. While we cannot guarantee that we will be successful in obtaining a favorable resolution of your case, I assure you that we will do everything that we can to assist you in a timely and effective manner.

Some health insurance companies require their own releases for me to assist you.  You may wish to check with my Rockville office for additional information

General Privacy Release Form

Immigration Privacy Release Form 

If your loved one is currently detained by U.S. Immigration and Customs Enforcement, please complete this form.

Please mail or fax your documents to the following address:

Congressman Chris Van Hollen
51 Monroe Street, Suite 507
Rockville, Maryland 20850

FAX: 301-424-5992