Help with a Federal Agency

Residents of the 6th Congressional District of New Jersey are encouraged to reach out to my office for assistance. Whether it be with a federal agency, such as Social Security or Veterans Affairs, an immigration issue, assistance with mortgage or foreclosure issues, or general questions about services available in your community, my staff is available to assist you.

In order to better serve you, the form below will generate a printable page that you should sign and mail to one of my offices: 504 Broadway, Long Branch, NJ 07740 or 67/69 Church St. New Brunswick, NJ 08901

If this is an immigration matter, please download the Immigration Privacy Release Form below and submit it to one of my offices. The general privacy release form is also available as a download, if you prefer to fill out the form by hand.

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

* indicates information that you need to provide.

In accordance with the Privacy Act of 1974, I give Congressman Frank Pallone Jr. authority to act on my behalf.

Your Information
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: (If Applicable)
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: (if there is no case number, indicate "None") *
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Telephone
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Nature of Problem
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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.

 

Downloads