Help with a Federal Agency - Print
Congressman Justin Amash
Please print, sign and mail/fax to our office.
Agency involved: [required-agency]
Numbers Identifying Case (VA claim, Alien number, tax ID, etc.): [required-numidcase]
Branch of Service (If Applicable): [branchOfService]
Military Rank (If Applicable): [militaryRank]
Date of Birth: [required-birth]
Social Security #: [required-ssnum]
Street Address: [required-address]
City, State, Zip Code: [required-city], [required-state] [required-zip5] [zip4]
Telephone #: [required-phone] [speech]
Email Address: [required-valid-email]
I, [required-name], authorize the [required-agency] to release personal information to Congressman Justin Amash United States Representative. I authorize Congressman Justin Amash to request and have access to all records and reports pertinent to my request for assistance in the following matter:
Nature of Problem: [required-problem]
The Privacy Act of 1974 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 a casework inquiry.
Print, and then mail or fax your request to Congressman Justin Amash at the following address.
Please mail your form to:
Office of Congressman Justin Amash
Attn: Constituent Services
110 Michigan St., Suite 460
Grand Rapids, MI 49503
Phone: (616) 451-8383
Fax: (616) 454-5630