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Federal Agency Casework Authorization Form

Residents of the 1st Congressional District of Maine 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.

Instructions

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.

Casework Information

* indicates required field.



Case Details


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.

  • HIDDEN_WEBSITE_VARIABLES

    How to use: Insert <span class="EXACT_VALUE_LABEL_AS_ENTERED_BELOW">&nbsp;</span> where you'd like the value to be populated.

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    Label
    (no spaces or special characters)

    Value

    		 Comments (optional)
    repName Chellie Pingree  
    helpWithFedAgencyAddress Office of Rep. Chellie Pingree
    Attn: Caseworker
    2 Portland Fish Pier, Suite 304
    Portland, ME 04101    		  
    district 1st District of Maine  
    academyUSCitizenDate July 1, 2012  
    academyAgeDate July 1, 2012  
    academyApplicationDueDate October 20, 2012  
    repStateABBR ME  
    repDistrict 1  
    repState Maine  
    repDistrictText 1st  
    repPhoto  
    SponsoredBills Sponsored Bills  
    CoSponsoredBills Co-Sponsored Bills  
         
         
         
         
         

  • Office Locations

    Office Name Location Image Map URL
    Washington DC 2229 Rayburn House Office
    Washington, DC 20515
    Phone: (202) 333-4455
    Fax: (202) 333-5522    		 http://goo.gl/maps/rqq9i
    Haverhill Office
    Serving Haverhill County
    1234 East. Courthouse
    Haverhill, CA 35602
    Phone: (202) 333-4455
    Fax: (202) 333-5522    		 http://goo.gl/maps/BCEEO
    South Office
    10 Welcome Street
    Tuesdays & Thursdays
    9:00 AM- 11:00 AM    		 http://goo.gl/maps/lodfk