I have the opportunity to assist Iowans in their dealings with federal agencies. My office can help with problems or questions about eligibility involving issues like Social Security, Medicare, veterans benefits or military affairs, passports, immigration issues, and other federal programs. 

Please use the following form to contact my office about your specific service request. In order to begin the casework process, please also complete the privacy release form located at the bottom of the page. Once a caseworker is assigned to your case, you will be contacted for additional information.

Casework Request Form

Note: Fields marked with an * are required.

123-456-7890
Human Validation

Privacy Release Form

In order to begin the casework process, please complete and submit a privacy release form authorizing a caseworker to communicate with a federal agency on your behalf. This form must be submitted to our Des Moines office in order for a caseworker to begin working on your case. 

Download the privacy release form here: