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To the best of my knowledge, I certify, under penalty of perjury, that 1) I provided or authorized all of the information in this privacy release and any document submitted with it; 2) I reviewed and understand all of the information contained in my privacy release and submitted with it; and 3) all of this information is complete, true, and correct.
I, (print your name) _____________________________________, authorize USCIS to release information contained in my USCIS records as relevant to checking my case status, and to the extent permitted by law, to Senator Alex Padilla and the Member’s staff.
Signature (sign in ink): _____________________________________ Date:
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I, (print your name)___________________________________ , authorize USCIS to release information contained in my USCIS records as relevant to checking my case status, and to the extent permitted by law, to Senator Alex Padilla and the Member’s staff.
Signature (sign in ink):_________________________________________ Date: _______/ _______/ _______
Phone:_________________________________________ Email: ___________________________
I am aware that provisions of the Privacy Act of 1974 (Public Law 93-579) may prohibit the release of information in covered agency files without my consent. I hereby give my consent for any applicable federal agency(ies) to release such information to the Office of United States Senator Alex Padilla and/or members of his staff in connection with my case or claim.
Signature: _____________________________________ Date: _______/ _______/ _______
The Federal Privacy Act of 1974 (Public Law 93-579) prohibits the disclosure by federal agencies of confidential information concerning your affairs without your written authorization. In order to properly assist you, please click the Download PDF icon in the upper-right corner of the PDF with your information, then sign the acknowledgement at the bottom by hand (no e-signatures will be accepted) and return it to my San Diego office by email, fax or mail. Contact information can be found at the bottom of the PDF or on the Office Location page of my website.
After you have read the statement above and downloaded the PDF, click "Confirm & Submit" button to finish.