Privacy Act Release Form Sample

For veterans casework you can download the privacy release form here. The privacy act release is doubly important for military veterans or immigrants who deal with agencies that need further information regarding their requests for service from any of the agencies. For immigration casework you can download the privacy release form here.

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Privacy act release form sample. I authorize access or release of. Privacy act release form. Consular office may contact and to whom to release information with regard to your case. Page 3 of 5.

Form g 639 06 20 19. For general casework you can download the privacy release form here. However there are some people who need to hand out their information to certain companies if these companies can help them out with particular situations. It could be that these companies need these private information before they can perform any kind of service.

Local language translations are acceptable to facilitate completion of the form in english. Release any information regarding you to anyone without your written consent except as set forth in the act. Description of records requested continued 15 d. To whom it may concern.

The proponent agency is the office of the inspector general. Although i am unable to guarantee a specific outcome my role is to assure you a fair and thorough review of your case and to seek a timely response from the agency. For use of this form see ar 20 1. The privacy act passed by congress in 1974 establishes certain controls over what personal information is collected by the federal government and.

Please sign and return this form to. One of the most important jobs i have is helping my constituents when they are having problems with federal agencies. Please complete the authorization below specifying whom a u s. I am aware that the privacy act of 1974 prohibits release of personal information without my.

Privacy act information release statement. Rank title first mi last name rank title first mi last name signature date y m d da form 7433 apr 2009. For example when dealing with social security issues the government agency concerned may ask for additional information before any considerations may be given. If you deny any part of this request please cite each specific exemption that you rely on to justify your refusal to release the information and notify me of appeal procedures available under the law.

Therefore a consent form must be completed before we proceed with your issue. Maiden name if applicable middle name given name. Please return the completed authorization to a u s.