* Issue for which you contacted my office:
* How would you rate the service provided by my staff member?
* How would you rate the information you received from the agency?
* How would you rate the attitude of my staff member assisting you?
* How would you rate the overall experience with my office?
* Additional comments/details about how U.S. Representative Deborah K. Ross helped me:
Permission for U.S. Representative Deborah K. Ross to use my story:I grant U.S. Representative Deborah K. Ross permission to publicize my name and my story of how her office assisted. In addition, I am aware that the Privacy Act of 1974 prohibits the release of my personal information without my expressed, written consent. If Congresswoman Ross uses information about your case it will only be general information. I hereby authorize U.S. Representative Deborah K. Ross to print my name and the story of the problem she helped me with on her website, social media accounts, and/or on other printed materials.