Other Request

While the topics listed above represent the subjects on which my office is contacted most frequently for assistance, there are a wide range of other issues that we can help you with. If you have an issue or concern that is not listed above, I still want to hear from you. Please fill out the online form below and be as specific as possible about your situation. You will also need to print, sign and send a privacy release (also below) to my Hartford office. Once it is received, a member of my Constituent Services team will contact you to discuss how we can best help resolve your issue. Please allow up to two weeks from the time we receive your privacy release for my office to contact you.

If your issue is urgent or time sensitive, please call my Hartford office at 860-258-6940 or toll-free at 800-334-5341 (in-state calls only).

Preview and Submit

This is a preview of your Request. Please confirm that all of the information below is correct before submitting. If you would like to make any changes to the information you have provided, please use the "Edit" button below. Using your browser's buttons to navigate will cause all form information to be lost.

Primary Contact Info

Your Name

Title*
- First Name*
- Middle Name
- Last Name*
- Suffix

Your Contact Information

- Email *
- Verify Email *
Phone Number *
Secondary Phone Number
Street Address *
Street Address (2)
- City*
- State*
- Zip Code*

Federal Agency Information

Federal Agency Involved *
With which office is your claim pending?
Contacted another congressional office? *
- Which office?
- When?

Description of Request

Your Request

A brief statement of what has occurred and what you would like as a result of the Senator’s involvement. *(please describe the problem in as much detail as necessary)

Preview and Send Request

Please click on the Preview button to review any information you have entered on this page.

Once you have reviewed your information on the next page, press the Print and Submit 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 my Hartford office by fax or mail.

Although the information on your form will be submitted to my office electronically, we cannot open an inquiry on your behalf until we receive your signed form.

Edit

Preview

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.