I certify, under penalty of perjury, that 1) I provided or authorized all of the information in this privacy release and any document submitted with it; 2) I reviewed and understand all of the information contained in my privacy release and submitted with it; 3) all of this information is complete, true, and correct. I authorize USCIS to release information contained in my USCIS records relevant to checking my case status to the extent permitted by law to the Office of Representative Diana Harshbarger and the Member’s staff. I understand that I am not required to make payment in any form for the services provide by my Member of Congress.

I hereby request the assistance of the Office of Representative Diana Harshbarger to resolve the matter described below. I authorize the Office of Representative Diana Harshbarger to receive any information that they might need to provide this assistance. The information I have provided to the Office of Representative Diana Harshbarger is true and accurate to the best of my knowledge and belief. The assistance I have requested from the Office of Representative Diana Harshbarger is in no way an attempt to evade or violate any federal, state, or local law.