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One of a Congressional office's primary functions is to provide direct service to constituents.  I’m proud to employ a full staff of case workers whose job is to help residents of the 12th Congressional District of New York. While we cannot guarantee you a favorable outcome, we will do our best to help you receive a fair and timely response from the government agency involved.

If you would like to make an official request, please first complete the privacy authorization form, in compliance with the provisions of the Privacy Act, by clicking the button below. Then after you've completed the privacy authorization form, fill out the rest of the form on this page and briefly describe the problem you are having. My staff will get back to you shortly in an effort to help you.

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Your Contact Information
First Name: *
Last Name: *
Email Address: *
Gender: *
Phone Number: *
Alternate Phone Number:
Street Address: *
City: *
State: *
Zip: *
Beneficiary Information (if different from above)
Beneficiary First Name:
Beneficiary Last Name:
Beneficiary Date of Birth:
Beneficiary Social Security Number:
Beneficiary Country of Origin:
Your Request
Choose an issue category from the drop-down list which most resembles your issue of concern. *
What do you need help with?: * (please describe the problem in as much detail as necessary)
Please provide any additional information that you think might be relevant to your case: *

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