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Click ‘Get Form’ to open it in the editor.
Begin by entering the date at the top of the form. This is essential for tracking your request.
In the 'Signed' section, provide your signature to authorize Congressman Gohmert to act on your behalf.
Fill in your name, including first, middle, and last names. Ensure accuracy as this will be used for identification.
Complete your physical and mailing addresses, including city, state, zip code, and county.
Provide contact numbers (work, cell, fax, home) and email address for effective communication.
Input your Social Security Number (SSN) or any relevant identification numbers as required.
Indicate if you have opened a case with another office and specify which one if applicable.
Select the federal agency related to your inquiry from the provided options.
Describe your situation briefly in the designated area. Use additional space if necessary on the back of the form.

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What is a privacy request form?

Requesting Your Records Under the Privacy Act 552a, as amended, allows individuals to gain access to their own personal records subject to certain exemptions, and to seek correction or amendment of records maintained by Federal agencies that are inaccurate, incomplete, untimely, or irrelevant.

What is a privacy release?

Under the provisions of the Privacy Act of 1974, I need to have formal authorization from you before making an inquiry to a federal agency on your behalf. This law was enacted to protect individuals from unauthorized disclosure of personal information without their consent.

Who is the beneficiary in the privacy release form?

The Privacy Release must be signed by the petitioner or the applicant, and NOT by the beneficiary. Petitioner/Applicant = A person or Employer who files an immigration petition or application. Beneficiary = A person who is a recipient of an immigrant benefit being sought by someone else.

What is a privacy release form?

The Privacy Release must include the following information: information is being requested (the subject of records). o Address includes the street number and name, city, state, and zip code. o A business is exempt from the date of birth and place of birth requirement.

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