Veterans

An inquiry can be made regarding the status of a claim for service-connected disability, payment of education benefits, medical care at VA facilities, or other problems. In order to assist a veteran with personal issues involving the U.S. Department of Veterans Affairs (VA), Senator Durbin must, by law, have a Privacy Act Release Form signed by the veteran or a friend or family member who has power-of-attorney.

Your Contact Information
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Home, work, mobile, other.
Home, work, mobile, other.
Case Details
Social Security No. format: XXX-XX-XXXX
Congressional Contact
Your Request
Please describe the problem in as much detail as necessary.

* The VA does not recognize power of attorney.

* Medal requests should be requested by Veterans, or if deceased, next of kin.



Preview and Send Request

Once you have reviewed your information, press the Print Privacy Release Form button. This will generate a PDF containing all of the information you have entered as well as a privacy release form. Please print the form, sign and date the last page, and return the form in its entirety to the Senator's office by fax or mail.

Preparing PDF...

Thank you for contacting me. The information on your form has been submitted electronically to my office. A PDF of your form is being generated automatically and should be ready within 10 seconds. If one is not available to download in that time, click here.

Once we have received your signed authorization, my staff will begin assessing how we can help. Please allow up to 30 days from the day we receive your release for my office to contact you. Thank you.