Privacy Form

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:

* indicates required field.

Your Information


Yes      No

Please include copies of any documentation you may have that would help expedite this inquiry. Please do not send originals.

Please note: By federal law (18 USC, Sec. 205), neither Congressman Mark Amodei nor his staff can involve themselves in private legal matters or represent constituents in judicial proceedings.


    How to use: Insert <span class="EXACT_VALUE_LABEL_AS_ENTERED_BELOW">&nbsp;</span> where you'd like the value to be populated.

    Non-breaking space within span tags - &nbsp; - is required for WYSIWYG.

    (no spaces or special characters)


    Comments (optional)
    repName Congressman Mark Amodei  
    helpWithFedAgencyAddress 332 Cannon House Office Building
    Washington, DC 20515
    district 2nd District of Nevada  
    academyUSCitizenDate July 1, 2016  
    academyAgeDate July 1, 2016  
    academyApplicationDueDate October 20, 2016  
    repStateABBR NV  
    repDistrict 2  
    repState Nevada  
    repDistrictText 2nd  
    SponsoredBills Sponsored Bills  
    CoSponsoredBills Co-Sponsored Bills  
  • Office Locations

    Office Name Location Image Map URL
    Reno Office 5310 Kietzke Lane, Suite 103
    Reno, NV 89511
    Phone: (775) 686-5760
    Fax: (775) 686-5711
    Washington Office
    332 Cannon House Office Building
    Washington, DC 20515
    Phone: (202) 225-6155
    Fax: (202) 225-5679
    Elko Office
    905 Railroad Street, Suite 104 D
    Elko, NV 89801
    Office: (775) 777-7705
    Fax: (775) 753-9984