Response

The Privacy Act of 1974 (Public Law 93-579) requires your written authorization for the congressional 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.

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First Name

Last Name

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City

State

Zip

Home Phone

Cell Phone

Work Phone

Date of Birth

Social Security Number

Other Number:

Have you spoken with Senator Luján or his staff regarding this concern? If so, who?

In addition to Senator Lujan's Office, please indicate any other congressional office or state office you have contacted:

In a few sentences, please describe what my office can assist you with.

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