Response

PRIVACY RELEASE and CONSTITUENT INFORMATION FORM

The Office of United States Senator Chris Coons is committed to providing timely, high-quality constituent services to Delawareans as they navigate the federal government. This service, often called “casework,” is available to all of Senator Coons' constituents and covers a variety of issues – from passport applications, to Social Security, to veterans’ benefits and other federal matters. While we can’t guarantee the outcome of your case, and our office cannot file, adjudicate, or appeal your case, we will work to ensure that the federal government is responsive to your concerns and that your rights are respected.

Under Senate Ethics Rules, our office cannot assist in judicial or legal matters, including child custody/support disputes, divorces, criminal trials, lawsuits, or imprisonment matters. Additionally, as a United States Senate Office, we have no jurisdiction over state issues such as:

State taxes
Domestic disagreements/disputes
State criminal justice/court decisions

If you have questions or concerns, please feel free to contact one of Senator Coons' state offices. Should you wish to file casework with the Office of Senator Coons, please complete the form below.

Pursuant to Public Law 93-579, the Privacy Act, I (i.e., the constituent) hereby authorize Senator Chris Coons and/or his staff to request and receive information from the appropriate federal agency or department in reference to my inquiry. This authorization includes written correspondence, telephonic, or any other means of communication. The federal agency or department is authorized to furnish copies of any documents, correspondence, or information relative to my inquiry until the matter is resolved.

RequiredDo you currently have a case pending before a federal, state, or local court pertaining to this matter?

Yes
No

Under Senate Ethics rules, Senator Coons' office cannot assist with a legal case or provide legal advice.

Your Name and Address

Prefix

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip

Cell Phone

Home Phone

Date of Birth

RequiredAre you currently working with the offices of Senator Blunt Rochester or Congresswoman McBride on this matter?

Yes
No

RequiredIf yes, please specify:

RequiredIf so, please provide their full name, contact information, and relationship to you:

RequiredWhat is the general nature of your request?

IRS/Taxes
USCIS/Immigration
All Other Requests for Help

RequiredFederal Government Agency Involved

RequiredSocial Security Number

Military Rank

Branch of Service

Date of Military Service - From (If applicable)

Date of Military Service - To (If applicable)

RequiredType of Return

**If you need assistance with a joint return, please download the Joint IRS Privacy Release Form from our website, complete and sign it with your spouse, then return to this page and upload the signed form below. Both your signature and your spouse's signature are required.

RequiredSpouse's Full Name

RequiredSpouse's Date of Birth

RequiredSpouse's Social Security Number

RequiredSpouse's Phone Number

RequiredSpouse's Email Address

RequiredTax Year(s)

RequiredTax Form(s)

RequiredCompany Name (as shown on return)

RequiredEmployer Identification Number (EIN)

RequiredYour relationship to the business:

RequiredType of Tax

RequiredIf other, please specify:

RequiredTax Year(s)/Periods

RequiredTax Form(s)

RequiredWhat is your relationship to the decedent?

RequiredDecedent's Full Name

RequiredDecedent's Date of Birth

RequiredDecedent's Social Security Number

RequiredDecedent's Latest Address

RequiredTax Type

RequiredTax Form Number(s)

RequiredOn whose behalf are you submitting this privacy release form?

RequiredIf other, please specify

Petitioner/Applicant

RequiredFull Name

RequiredDate of Birth

RequiredAlien Number

RequiredCountry of Birth

Beneficiary

RequiredFull Name

RequiredDate of Birth

RequiredAlien Number

RequiredCountry of Birth

USCIS receipt number or tracking number

RequiredDate of Filing

RequiredIf other, please specify

This section is to be completed by the subject of the inquiry.

I certify, under penalty of perjury, that 1) I provided or authorized all of the information in this privacy release and any document submitted with it; 2) I reviewed and understand all of the information contained in my privacy release and submitted with it; and 3) all of this information is complete, true, and correct.

RequiredI, [YOUR NAME HERE], authorize USCIS to release information contained in my USCIS records as relevant

to checking my case status, and to the extent permitted by law, to Senator Chris Coons and the Member's staff.

RequiredBriefly explain the problem. Attach copies of any relevant documentation in the attachment area provided below.

Attach copies of any relevant documentation here. ***Allowed file types: .doc, .docx, or .pdf***

You may upload multiple attachments, however there is a cumulative maximum file size limit = 15MB. You may send additional documentation directly to the staff member assigned to your case after they have made contact with you.

Upload FileNo file chosen

The signature must be from an individual who is 18 years of age or older and is requesting assistance or has a pending case with a federal agency. If the individual is unable to sign, a legally authorized representative - such as someone holding power of attorney or a legal guardian - may sign on their behalf. Proper documentation confirming the representative's legal authority must be provided. Third-party signatures, including those of immediate family members without legal authority, are not acceptable. Federal agencies will not release information without the signed consent of the appropriate individual or their authorized representative.

RequiredToday's Date

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