Congressman Frank Wolf

Representing the 10th District of Virginia

Privacy Release

Before my office can start working on your case, I need you to fill out a privacy release giving my staff permission to contact agencies on your behalf. Below are two options of how you can submit your privacy release. Option 1 is the PDF Version: Option 2 is the web version of the Authorization Form.

Please contact me or my staff if you have any questions about the privacy release.

Option 1: PDF Version

This form is in Adobe Acrobat format and you can complete it on screen, but, you must have Adobe Acrobat Reader installed to view a PDF file. Once you fill out the form, print it and then mail or fax it to my Herndon office.

Congressman Frank Wolf

13873 Park Center Rd, Ste 130

Herndon, VA 20171-5802

Fax: (703) 709-5802

Option 2: Authorization Form

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

Your Information

Full Name:

Street Address

City

State

Zip Code

Email:

Social Security Number

Agency case number(s): (*My office needs these identification numbers to assist in handling you case. If there is no case number, indicate "None")

Telephone

Home Number:

Voice VP TTD

Work Number:

Voice VP TTD

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.

Print This Form

Use the Generate Request button to produce the document to authorize my office to help you. Please include a complete written description of your situation and enclose photocopies of pertinent documents, letters and certificates. PLEASE DO NOT SEND ORIGINAL COPIES OF ANY DOCUMENTS.