Indicates required field Contact InformationFirst Name: MILast Name: AddressAddressCity/TownState/Province- Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZIP/Postal CodeEmail:TelephonePhone NumberPhone Type:- None -Standard voice telephoneVideophone [VP]Text-telephone device [TTD]What are these options?Constituents who are hard of hearing or use a video phone have the option to choose TDD or VP based on the type of device they are using. This allows our office to respond to them accordingly. The default option 'Voice' is a standard audible telephone.Casework Details Alien Registration (A#):Date of Birth:MonthDayYearPlace of Birth:Petition/Application Filed (Example I-130, I-485, N-400):Date of Filing:Receipt Number:Have you contacted any other elected official on this case? - Select -YesNoPlease Explain the problem and the resolution/outcome you are seeking:Constituent Authorization To be able to assist you, we must have a signed privacy release form that clearly outlines your problem and the remedy you are seeking. By checking the box below you are giving our office permission to look into the matter on your behalf. Please make sure to attach below any relevant identifying information and supporting documents which relate to your inquiry. I have requested assistance from Congressman Lloyd K. Smucker on a matter that may require the release of information covered by the Privacy Act of 1974. Under penalty of perjury, all the information contained in my privacy release is complete, true, and correct. Pursuant to the Privacy Act of 1974 and U.S. Department of Homeland Security policy, I hereby consent to the disclosure to Congressman Lloyd K. Smucker or his staff of any record pertaining to me that appears in any system of records of U.S. Citizenship and Immigration Services, U.S. Customs and Border Protection, U.S. Immigration and Customs Enforcement, of the U.S. Department of State. How were you referred to our office? Please select one.:How were you referred to our office? Please select one.:- Select -Other Governmental Agency AdvertisingFriend/Family/ColleagueSocial MediaWebsiteOther…Enter other… CAPTCHA: enabled to secure this form. If you are having difficulty using Captcha's visual option, please visit the Accessibility page for more assistance.