Congressman Mark Takano

Representing the 41st District of California

Help with a Federal Agency

Table of Contents

Help with Federal Agencies

It can often be difficult to navigate our federal bureaucracy. As your Representative, my office is here to help you receive the answers you need from a federal agency. My district office can help ensure you receive reliable information, proper forms, as well as inquire on your behalf with a federal agency. While we cannot guarantee you a favorable outcome, my office will do their best to help you receive a fair and timely response to your problem.

Authorization Form

Residents of the 41st 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 all cases;
  • Your VA claim number for a case with Department of Veterans Affairs;
  • Your A# for all cases pertaining to US Customs and Immigration Services;
  • 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;
  • A brief description of the problem or issue you are having with the respective agency

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 Mark Takano authority to act on my behalf.

Your Information
Telephone
 

What are these options?
This is to help the constituents that are hard of hearing or use a video phone alert us to that fact so we can use the proper technology when we need to call them. The default option “Voice” is a normal audible telephone.

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.