Step 1

Ensure that the person requesting assistance lives in the Fifth District of Minnesota.

Step 2

Fill out this form and press the "Send & Print Privacy Form" at the bottom of the page.

If you have questions about this form, please call 612-522-1212

Step 3

Print out the privacy authorization form on the next page and have the person requesting assistance sign it.

Important: Due to the Privacy Act, a copy of the signed form must be faxed, e-mailed or mailed to our Minneapolis office before we can begin assisting you.