Due to the provisions of the Privacy Act of 1974, permission in writing is required before making an inquiry on your behalf. Completing and signing this form authorizes U.S. Senator Rand Paul and those acting on his behalf to make inquiries to the appropriate federal agency on your behalf.

IF APPLICABLE TO YOUR REQUEST FOR ASSISTANCE, PLEASE PROVIDE THE FOLLOWING INFORMATION:

I hereby certify, under penalty of perjury, that (1) I provide and authorize this information, (2) I reviewed and understand the provided information, and (3) that all the information is complete, true and correct. I provide and authorize the information and documents to be received and reviewed by Senator Paul and his staff, and authorize this request/information to be forwarded to any federal agency for further review on my behalf. I also authorize the receipt of information from any federal agency, to the office of Senator Paul, relevant to the matter described.

Submit with the Release, a copy of the last agency decision (EX: USCIS Receipt Notice, VA Decision, etc), and any other documentation that will be helpful in my research on your behalf.