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If you can't get an answer from a federal agency in a timely fashion, or if you feel you have been treated unfairly, my office may be able to help. 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.

Residents of the 10th Congressional District of California can contact me for assistance in dealing with federal agencies. In order to expedite your service, 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 a case involving Social Security);
  • VA claim number (for a case involving the 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; and
  • copies of any related documents or correspondence that you may have from the agency involved.

Important 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 your request for assistance. By printing and mailing this form, we are able to process your request more quickly.



Your Information
Today's Date:
* Prefix:
* First Name:
* Last Name:
* Street Address:
* City:
* State:
* Zip:
* Phone Number:
* Email:
* Date of Birth:
* Social Security Number:
Case Information
* Agency Involved:
* Agency Case Number(s): (if there is no case number, indicate "None")
Branch of Service: (if applicable)
Military Rank: (if applicable)
* 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.