Privacy Waiver Authorizing Disclosure to a Third Party
If you are a resident of the Fourth District and have been impacted by the operations of Border Patrol and ICE agents in North Carolina, please contact my office at 919-967-7924 for assistance.
Use this form to authorize the U.S. Department of Homeland Security (“DHS”) to disclose information and/or records about you to a third party. Taking this action is entirely voluntary; you are under no obligation to consent to the release of your information to any third party. Authority: Privacy Act of 1974 (5 U.S.C. § 552a); DHS Privacy Act Regulations (6 C.F.R. § 5.21(d)).