Federal Agency Help

Under the Privacy Act of 1974, federal agencies are prohibited from disclosing information from your files to anyone without your written authorization. By completing this form and signing the PRIVACY ACT statement below, you are authorizing the federal agency involved to disclose such information to Congressman Gregg Harper and/or members of his staff. Such information will be kept confidential by them.

Please complete the requested information below, print and mail, email or fax to Congressman Harper's Pearl office.

* indicates information that you need to provide.

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

Your Information
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Your Spouse Information (if applicable)

If the assistance needed is with the military or Veterans Affairs, please provide the following information
city where service member enlisted

Nature of Problem
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Print This Form

Use the Generate Request button to produce the document to authorize Congressman Harper's 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 Congressman Harper's office help you.