Collection of the information in this Claim form is authorized by 5 U.S.C. § 552a. This information will be disclosed to the Department of the Treasury and its fiscal and financial agents, and other federal agencies, as necessary to process your claim. This information may also be disclosed to a court, congressional committee or another government agency as authorized or required to verify your receipt of federal payments. Although providing the requested information is voluntary, your claim cannot be processed without it.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | John Wesley Powe III |
| File Modified | 0000-00-00 |
| File Created | 2021-01-15 |