Congressman Pete King

Representing the 2nd District of New York

Privacy Release Form

If you can't get an answer from a federal agency in a timely fashion, or if you feel you have been treated unfairly, my office may be able to help resolve a problem or get you the information you need. While we cannot guarantee you a favorable outcome, we will do our best to help you receive a fair and timely response to your problem.

Residents of the 2nd Congressional District of New York can contact me for assistance in dealing with Federal agencies. In order to better serve you, this form will generate a printable page that you should sign and mail to my office.

Please include all pertinent information and claim numbers in your correspondence—such as:

  • Your Social Security number for a case involving Social Security;
  • VA claim number for a case with Department of Veterans Affairs;
  • Taxpayer identification number (Social Security number, if individual) for an Internal Revenue Service problem, etc.;
  • Your address, home phone number and daytime phone number (if different than home) so that we can obtain any additional information from you that might be necessary;
  • Copies of any related documents or correspondence that you may have from the agency involved;

Please Note:

The Privacy Act of 1974 (5 U.S.C. § 552a) requires that Members of Congress or their staff have written authorization before they can obtain information about an individual's case.
We must have your signature to proceed with this type of request.


Authorization Form

To print out the Congressman's privacy release form as a Word document, please click here: Rep. King Privacy Release Form Word.doc

To fillout out and print on-line, use the below form.

* indicates information that you need to provide.

In accordance with the Privacy Act of 1974, I give Congressman Pete King authority to act on my behalf.

Your Information
Telephone
 

What are these options?
This is to help the constituents that are hard of hearing or use a video phone alert us to that fact so we can use the proper technology when we need to call them. The default option “Voice” is a normal audible telephone.

Nature of Problem

Print This Form

Use the Generate Request button to produce the document to authorize my office to help you. Then sign it and mail it to the address shown on the document. Please include any other documents or material that you think would help my office help you.