United States Senator James E. Risch

Privacy Release Form

Before Senator Risch can make inquiries on your behalf, many federal agencies require that you send us a signed copy of the Privacy Act Waiver. Please fill out the information below, then manually fill out the Social Security number and signature fields before mailing or faxing to Senator Risch's office.

Due to the Privacy Act of 1974 (PL 93-579) Federal and State agencies are prohibited from releasing information or discussing anything regarding an individual without that person's written permission. Your signature on this page authorizes me and my representatives to contact the appropriate officials on your behalf, discuss the issue, and receive any appropriate information. Your signature also gives us permission to send a copy of this form and any attached letters or supporting documentation to the appropriate agency. Please know that we respect your privacy and will provide your documents only to those agencies or individuals who are involved in your case.

Please Note: this form is for printing only; this information will not be transferred by email or into a database.
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Due to the Privacy Act of 1974 (PL 93-579) Federal agencies may be prohibited from releasing information or discussing anything regarding another individual without that person's written permission. 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 accurate to the best of my knowledge. I authorize Senator Risch, and/or his staff, to contact the proper officials on my behalf, discuss the issue, and receive any pertinent information. My Signature also gives Senator Risch, and/or his staff, permission to send a copy of this form and any attached letters or supporting documents to the appropriate agency.