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Please include all pertinent information and claim numbers in your correspondence—such as:
Please mail completed form to: Office of Congressman Erik Paulsen Attn: Constituent Services 127 Cannon HOB Washington, D.C. 20515
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.
* indicates information that you need to provide.
In accordance with the Privacy Act of 1974, I give Congressman Erik Paulsen authority to act on my behalf.
Today's date:*
First Name:*
Last Name:*
Agency Involved*
Branch of Service (If applicable)
Military Rank (If applicable)
Agency Case Number (If there is no case number, indicate "None")
Date of Birth:*
Social Security Number:*
Street Address:*
Address 2:
City:*
State:* Minnesota
Zip Code:* +4 (Determine your ZIP+4)
E-mail Address:*
Phone:*
Type:* Voice VT TTD
Please explain nature of the problem:*
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.