Due to the privacy act of 1974, I need your signed written permission if you would like my help with a Social Security Administration claim or appeal. Please print out this Authorization Form and fax it to my district office at 614-818-0887, or mail it to my district office at :

Congressman Patrick J. Tiberi
3000 Corporate Exchange Drive, Rm 310
Columbus, Ohio 43231

If you have require immediate assistance with a Social Security Administration problem, call my district office at 614-523-2555.