Response

Privacy Act Waiver

Senator Carper’s office is here to help Delawareans as they navigate assistance available from the federal government. The office can help with Veterans and Active Duty Military, Social Security, Medicare, the Small Business Administration, Federal Taxes, Immigration, Passports, and other federal agency related issues.

Senator Carper’s staff can help Delawareans communicate and get in touch with federal agencies. The Senator’s office cannot promise you a specific outcome from an agency or referral, however the office will do it’s best to help you receive a full and fair response.

If you’re seeking assistance from the Senator’s office, please fill out the form below.

Please complete a separate form for each person seeking assistance.

The Privacy Act of 1974, P.L. 93-579, became fully effective on September 27, 1975. The purpose of the Privacy Act is to control the federal government's collection and dissemination of personal information about individual citizens. 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

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Date of Birth

Phone

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As Senator Carper travels around the State, many Delawareans share their stories of the assistance they have received.

Please indicate below if you would like to authorize the Office of U.S. Senator Tom Carper and/or his staff to publicly share information about your case (please note your authorization in no way affects the assistance U.S. Senator Tom Carper and his staff will provide you.)

Social Security Number:

Medicare Number:

Veterans Affairs Claim Number:

Branch of Service:

Dates of Service Started in Month and Year:

Dates of Service Ended in Month and Year:

Immigration 'A' Number

IRS Case #

Tax Year

Other Relevant Case Number:

Have you contacted another congressional office?

Which Offices? (Please select all that apply).

Office of Senator Chris Coons

Office of Representative Lisa Blunt Rochester

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How did you hear about our constituent services?

Briefly describe the concern(s) or problem(s) you are having with a federal agency:

Describe the specific resolution you are hoping for:

I authorize Senator Tom Carper and/or his representatives to request any relevant information in order to assist in responding to my inquiry, in accordance with the provisions of the law. l declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. I authorize Senator Tom Carper and/or his representatives to request any relevant information in order to assist in responding to my inquiry, in accordance with the provisions of the law. l declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct.

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