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Congressman C.A. Dutch Ruppersberger

Representing the 2nd District of Maryland

Privacy Act Release Forms

One of the most important jobs I have is helping my constituents when they are having problems with federal agencies. Although I am unable to guarantee a specific outcome, my role is to assure you a fair and thorough review of your case and to seek a timely response from the agency.
 
Click here for a quick quide to help determine if my office can assist you in your case. Once you have determined that your case is something my office may be able to assist you with, complete the following questions to generate a printable Privacy Act Release form. 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.
 
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.

Authorization Forms

 

General Privacy Act Release Form

Foreclosure Privacy Act Release Form

Immigration Privacy Act Release Form

Social Security Privacy Act Release Form