Constituent Consent & Information Form
In order for my office to assist you, please fill out the consent and information form.
Under the Privacy Act of 1974, we must have formal authorization from you before seeking disclosure of your records. The authorization must be signed by the person whose case is in question.
In accordance with the Privacy Act of 1974 (5 USC 552), you must certifty under penalty of perjury that you authorize Representative Robert C. "Bobby" Scott and his designated staff to seek disclosure of all records relevant to my case from the federal agency involved.
Please note: If you prefer to submit the Consent and Informaiton form via fax, mail, or in person, please fill out, print, and sign the form below.
In order to better serve you, this form will generate a printable page that you should sign and mail or fax to my District Office:
2600 Washington Ave, Suite 1010
Newport News, VA 23607
Tele: (757) 380-1000
Fax: (757) 928-6694
*indicates information that you need to provide.
If you can't get an answer from a federal agency in a timely fashion, or if you feel you have been treated unfairly, our 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 3rd Congressional District of Virginia can contact us 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 our 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;
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. You will review, print, and sign the document after it's generated from the information you enter below.
This is a three step process:
- Fill in the form with the required data, then click the “Generate Request for Review” button at the bottom of the page.
- Review the form to ensure all data is accurate, then sign the form.
- Print and mail, fax, or hand deliver the document to our office. The address and fax number are on the generated page.