Congresswoman Chellie Pingree

Representing the 1st District of Maine

Federal Agency Casework Authorization Form

Residents of the 1st Congressional District of Maine can contact me for assistance in dealing with Federal agencies. In order to better serve you, this form will generate a printable page that you should sign and mail to my office.


Please include all pertinent information and claim numbers in your correspondence, such as:

  • Your Social Security number for a case involving Social Security;
  • VA claim number for a case with Department of Veterans Affairs;
  • Taxpayer identification number (Social Security number, if individual) for an Internal Revenue Service problem, etc.;
  • Your address, home phone number and daytime phone number (if different than home) so that we can obtain any additional information from you that might be necessary;
  • Copies of any related documents or correspondence that you may have from the agency involved.

Please Note:

The Privacy Act of 1974 (5 U.S.C. § 552a) requires that Members of Congress or their staff have written authorization before they can obtain information about an individual's case. We must have your signature to proceed with this type of request.

Authorization Form

indicates information that you need to provide.

In accordance with the Privacy Act of 1974, I give Congresswoman Chellie Pingree authority to act on my behalf.

Your Information
Case Details
Nature of Problem

Print This Form

Use the Generate Request button to produce the document to authorize my office to help you. Then sign it and mail it to the address shown on the document. Please include any other documents or material that you think would help my office help you.