Help With a Federal Agency


The Privacy Act of 1974 prohibits the disclosure of personal information without the individual’s written consent. In order for the Senator’s office to open a case on your behalf, please complete this form and return it to one of her offices located in Illinois. Please include copies of any relevant documents.


Privacy Act Release From


Attach copies of any relevant documents or notices here. Allowed file types include .doc, .docx, .jpeg, .pdf, or .txt. Total file size limit is 15MB.

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