Help with a federal agency - immigration

This Privacy Act generally requires your written consent before a government agency will release information to my office regarding your records. To better serve you, please complete this form, print it out, and return it with your signature to the address at the bottom of this page.

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First Name*

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Last Name*

Date of Birth*

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Mailing Address*

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Email*

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Petition/Receipt/A #

Request Details

Briefly explain your problem and outline the steps that have been taken by you and the agency with regard to your situation. In addition, please make your request for assistance as specific as possible. Should you require more room, feel free to attach a letter addressed directly to the Senator.

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In accordance with the provision of the Privacy Act of 1974, I authorize the Office of U.S. Senator Dan Sullivan to obtain information about me from covered agencies in connection with my case. To the best of my knowledge, the information I provided is complete, true, and correct.

Print This Form

Use the “Generate Request” button to produce the document to authorize my office to help you. Please print, sign, date, and mail it to the address shown on the document, and listed below. Please include any other documents or materials that you think would help my office help you.

U.S. Senator Dan Sullivan
Anchorage Field Office
510 L Street, Suite 750
Anchorage, AK 99501
Phone: 907.271.5915
Fax: 202.228.4562
Email: casework_sullivan@sullivan.senate.gov

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PDF Signature

PRIVACY ACT: In accordance with the provision of the Privacy Act of 1974, I authorize the Office of U.S. Senator Dan Sullivan to obtain information about me from covered agencies in connection with my case. To the best of my knowledge, the information I provided is complete, true, and correct.

Signed ____________________________________________

Date: ____ / ____ / ____

Please email, mail, or fax the signed and completed form and any attachments to:

U.S. Senator Dan Sullivan
Anchorage Field Office
510 L Street, Suite 750
Anchorage, AK 99501
Phone: 907-271-5915
Fax: 202-228-4562
Email: casework_sullivan@sullivan.senate.gov