Authorization Form

* marks required fields of data.

Your Information

What are these options?
Constituents who are hard of hearing or use a video phone have the option to choose TDD or VP based on the type of device they are using. This allows our office to respond to them accordingly. The default option "Voice" is a standard audible telephone.

Please do not include your social security number if your case inquiry is immigration-related. This form requires you to print, sign, and mail or hand deliver the signed document. Your social security number will not be transmitted electronically.
Agency/Military Information
Immigration-related Information

Print This Form

Use the "Generate Request for Review" button below to produce the document to authorize our office to help you. Print, sign, and mail or hand deliver it to the address shown on the document. Please include any other documents or material that you think would help our office help you.