Privacy Act Waiver

Gary’s office stands ready to help you understand your rights and responsibilities related to various federal programs and help you work through a problem you may have with a federal agency. Acting as a liaison between you and the federal government, our staff can often help you answer questions, find resources or resolve problems. Our office cannot promise you a specific outcome from an agency or referral. We will do our best to help you receive a full and fair response.

Please complete this form for immigration, USCIS, State Department and Visa issues. Please complete the beneficiary section ONLY IF you have filed for an immigration benefit on behalf of another individual. Please leave the beneficiary section blank if you are filing for an immigration benefit for your yourself.

The Privacy Act of 1974 (Public Law 93-579) requires your written authorization for my office to contact government agencies on your behalf or discuss your case in detail. The Privacy Act authorizes the disclosure of records to congressional offices acting on behalf of constituents only when the individual has consented.



Please attach a copy of your receipt, I-797 Notice of Action, and most recent supporting documents, up to three files and no larger than 15MB a piece. 



Sign using your mouse or finger...