If you can't get an answer from a federal agency in a timely fashion, or if you feel you have been treated unfairly, our office may be able to help resolve a problem or get you the information you need. While we cannot guarantee you a favorable outcome, we will do our best to help you receive a fair and timely response to your problem.

Please complete as many fields in the form below as possible, required fields are noted. You will be asked for your date of birth and social security number and then you will be asked to print the generated form and mail or fax it to our office.

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.

Note: Fields marked with an * are required.

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

Your Information

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.

Related Links