Rep. Seth Moulton - Privacy Act Release form 091615.docx - moulton house 2026

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The document is a Casework Authorization and Privacy Act Release Form for constituents of U.S. Representative Seth Moulton from Massachusetts. It allows individuals to authorize the representative and his staff to inquire on their behalf regarding specific issues or cases, while ensuring compliance with privacy regulations. The form collects personal information, details about the issue at hand, and requests the desired outcome from the representative's office.

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Click ‘Get Form’ to open it in the editor.
Begin by filling in your name and date at the top of the form. Ensure that all personal information is accurate.
Provide your home address, including city and ZIP code, followed by your home and work phone numbers.
Enter your email address and any relevant identification numbers, such as Social Security Number or Veteran Case ID.
Indicate if you are working with another Massachusetts Delegation member and provide details if applicable.
In the section regarding agencies contacted, list any relevant agencies along with dates and results of inquiries.
Sign and date the authorization section, allowing Representative Seth Moulton to act on your behalf.
Finally, return the completed form to the specified office address within 30 days for processing.

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