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Privacy Act Consent Form

Please fill out all fields and a print form will be generated. Write in your social security number (required), sign the form (required) and fax it to the district office nearest to you.

I am aware that the Privacy Act of 1974 prohibits the release of information in my file without my approval. I hereby authorize Congresswoman Niki Tsongas or her representative to inquire with the following agency on my behalf:

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Please note: By federal law (18 USC, Sec. 205), neither Congresswoman Tsongas nor her staff can involve themselves in private legal matters or represent constituents in judicial proceedings.