Constituent Consent & Information Form

In order for my office to assist you, please fill out the consent and information form below.

Please Note:

Under the Privacy Act of 1974, we must have formal authorization from you before seeking disclosure of your records. The authorization must be signed by the person whose case is in question.

In accordance with the Privacy Act of 1974 (5 USC 552), I hereby authorize Representative Robert C. Scott and his designated staff to seek disclosure of all records relevant to my case from the federal agency involved.

In order to better serve you, this form will generate a printable page that you should sign and mail or fax to my Hampton Roads district office:

Authorization Form

*indicates information that you need to provide.