Indicates required field Office of Speaker Emerita Nancy Pelosi Instructions It is possible that resolution of your casework matter could extend beyond the duration of my service as your elected Member of Congress. In that event, I ask that you please complete this short survey regarding your disposition preference for your active casework. Constituent Information . Prefix - Select -Ms.Miss.Mrs.Mr.Mr. and Mrs.Rev.Dr.The HonorableRabbi First Name MI Last Name Suffix - None -2nd3rd4thIIIIIIVJr.Sr.M.D.PH.D.and Family Address Line 1 Address Line 2 City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUS Virgin IslandsUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Email Address Phone Number Phone 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 can choose TDD or VP depending on their device. This allows us to respond accordingly. The default 'Voice' is an audible telephone. Casework Transfer Preference Please indicate your preference regarding disposition of your active casework information by choosing the option that best applies: Transfer all my casework information to my incoming House member. I prefer that all my casework information, including all related agency communications, be transferred to the incoming Member of Congress. I understand that I will be required to sign a new privacy release form (PRF) with the incoming Member of Congress to allow them to continue to work on my case. Transfer only limited information about my casework to my incoming House member. I prefer that only limited casework information and agency communications associated with all my casework be shared with the incoming Member of Congress. This information includes only my name, contact information, and the agency with which my casework resides. I understand that I will be required to sign a new PRF through the incoming Member of Congress to allow them to continue to work on my case. Transfer my casework to one of my Senators. I prefer that all my casework information, including all related agency communications, be transferred to one of my U.S. Senators. I understand that I will be required to sign a new PRF through the Senator’s office to allow them to continue to work on my case. Terminate my Case. I prefer that my casework be terminated. CAPTCHA: enabled to secure this form. Member - Select -Office of Representative Firstname LastnameOffice of Representative Andy BiggsOffice of Representative Raul RuizOffice of Speaker Emerita Nancy PelosiOffice of Representative Sam GravesOffice of Representative Jared GoldenOffice of Representative Cleo Fields Office of Representative Robert GarciaOffice of Representative Julie Johnson Office of Representative Andy OglesOffice of Representative Buddy CarterOffice of Representative David Schweikert