UNITED STATES SENATOR FOR OHIO
37 West Broad Street, Room 300 • Columbus, OH, 43215 • Phone: (614) 369-4925
PRIVACY RELEASE and CONSTITUENT INFORMATION FORM
The office of U.S. Senator JD Vance is happy to help in your interactions with agencies and offices of the federal government. Assistance is available to all Ohioans and covers a variety of issues. Among other topics, the Senator's office routinely receives inquiries about pending cases from passport applications to Social Security and veterans’ benefits. While our office cannot file, adjudicate, or appeal your case, we will work to ensure the federal government is responsive to your concerns. Additionally, the work our office provides on a constituent’s behalf does not create an attorney-client relationship and is not a substitute for legal representation.
Due to the Constitution’s separation of powers, Senator Vance cannot assist in judicial or court matters, including child custody/support, divorce, criminal trials, lawsuits or imprisonment. Additionally as a United States Senator, he has no jurisdiction over state issues such as:
Pursuant to Public Law 93-579, the Privacy Act, I (i.e., the constituent) hereby authorize Senator JD Vance 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.
Attach copies of any relevant documentation. ***NOTE: ALL ATTACHMENTS MUST BE .doc, .docx, .pdf, or .txt (i.e., NO PHOTOGRAPHS).*** Maximum file size = 15MB. You may send additional documentation directly to your caseworker after they have made contact with you.
I am aware that provisions of the Privacy Act of 1974 (Public Law 93-579) prohibit the release of information in my file without my approval. I hereby authorize the above-mentioned agency (agencies) to provide information regarding my case or claim to the Office of United States Senator JD Vance. I certify, under penalty or 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 to be fully compliant with 6CR 5.21(d).