Casework Test Page

In order for my office to help you with your request, we first need to know some basic contact information. Please fill out the form below and then continue to the next step by selecting the specific type of request.

After completion of this form, someone from our office will reach out to you to help with the completion of a signed statement that is required by The Privacy Act of 1974 before we can begin working on your case.

When completing this form, if you know the specific agency you need assistance with, please select the agency in the ‘Specify Your Request’ field at the bottom of the form and complete the prompts that come up afterward. If you do not know the specific agency you need assistance with, please submit a brief description of your issue in the ‘Please Explain’ field instead. To ensure we can help you as quickly as possible, please complete one or the other before hitting the submit button.

"*" indicates required fields

Your Information

First Name*

Middle Initial

Last Name*

Date of Birth*

Social Security Number

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Enter Email Confirm Email

Day Phone Number*

Evening Phone Number

Specify your Request

Please Explain

Claim Number

Please list other individuals with whom you authorize the release of information on your case:

Relationship

Name

Relationship

Name

Veterans/Military

VA Claim Number*

Branch of Service*

Military Rank

Date of Service From:*

Date of Service To:*

Are you the veteran?*

First name*

Middle Initial

Last Name*

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone Number*

Alternate Phone Number

This field is hidden when viewing the form

Section Break

If your request relates to an Immigration/Homeland Security/USCIS/State Department/ICE/Visas inquiry, please download THIS form, fill it out completely and send to the address below.

Office of U.S. Senator Chris Coons
Attn: Constituent Affairs
1105 N. Market Street, Suite 100
Wilimington, DE 19801-1233
fax: 302-573-6351

If your request relates to an IRS inquiry, please download THIS form, fill it out completely and send to the address below.

Office of U.S. Senator Chris Coons
Attn: Constituent Affairs
1105 N. Market Street, Suite 100
Wilimington, DE 19801-1233
fax: 302-573-6351

Are you currently working with another congressional office?*

NATURE OF PROBLEM: Please provide a complete statement on the reverse side of this form regarding the nature of the problem and the assistance needed from the office of Senator Christopher Coons. Please attach copies of any additional pertinent documents.

Statement*

As quickly as we receive your request, we will acknowledge receipt of your information and provide information about how to move forward. Please have available copies of all correspondence you have received from the federal agency involved. Please only use the form below to submit your request.

Caseworkers can help residents understand their individual problems involving Social Security, Medicare, veterans or military affairs, federal taxes, passports, or immigration issues. In the event of an emergency, please call our Wilmington office at 302-573-6345, our Dover office at 302- 736-5601, or toll-free at (877) 668-3368.

As a United States Senator, only federal issues fall within Senator Coons' jurisdiction. If your problem involves an agency of the State of Delaware, you may first want to make an inquiry with the Governor of Delaware or your member of the Delaware General Assembly.

Print This Form

Use the “Generate Request” button to produce the document to authorize my office to help you. Please print, sign, date, and mail it to the address shown on the document. Please include any other documents or materials that you think would help my office help you.