Casework Request

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Casework Details
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Name

Prefix:

First Name:

Last Name:

Suffix:

Date of Birth:

Month

Day

Year

Your Contact Information

Address

Address 2

City

State

ZIP Code

Email:

Phone Number

Phone Type:

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.

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