Help with a Federal Agency - Print
Congresswoman Tulsi Gabbard
Please print, sign and mail/fax to our office.
Agency involved: [required-agency]
Numbers Identifying Case (VA claim, Alien number, tax ID, etc.): [required-numidcase]
Other Congressional, Federal, or State offices you have already contacted about this issue: [other-agency]
Branch of Service (If Applicable): [branchOfService]
Military Rank (If Applicable): [militaryRank]
Date of Birth: [required-birth]
Street Address: [required-address]
City, State, Zip Code: [required-city], [required-state] [required-zip]
Telephone #: [required-phone] [speech]
Email Address: [required-valid-email]
I, [required-name], authorize the [required-agency] to release personal information to Congresswoman Tulsi Gabbard United States Representative. I authorize Congresswoman Tulsi Gabbard to request and have access to all records and reports pertinent to my request for his assistance in the following matter:
Nature of Problem: [required-problem]
The Privacy Act of 1974 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 a casework inquiry.
Print, and then mail or fax your request to Congresswoman Tulsi Gabbard at the following address.
Please mail your form to:
Office of Congresswoman Tulsi Gabbard
Attn: Constituent Services
300 Ala Moana Blvd, Room 5-104
Honolulu, HI 96850
Phone: (808) 541-1986
Fax: (808) 538-0233