Privacy Consent Act Form
Please fill out all fields and a print form will be generated. Write in your social security number (required), sign the form (required) and fax it to the district office nearest you.
I am aware that the Privacy Act of 1974 prohibits the release of information in my file without my approval. I hereby authorize Congressman Mark Amodei or his representative to inquire with the following agency on my behalf:
* marks required fields of data.