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Casework Assistance Request Form

If you need assistance with any state agency or need help resolving a case with a state department, please complete the form below. Our office is here to help!

Note: Once submitted, a member of our team will reach out to you as soon as possible. If you need immediate assistance, please call our office directly at (661) 286-1565.

Full Name

First

Middle

Last

Date of Birth

Address

City/Town

State/Province

ZIP/Postal Code

Phone Number (Please include area code)

Email Address (For follow-up communication)

Agency You Need Assistance With (Select one or more)

Employment Development Department (EDD)

California Public Utilities Commission (CPUC)

Department of Consumer Affairs (DCA)

Department of Motor Vehicles (DMV)

Department of Healthcare Services (DHCS)

Department of Managed Healthcare (DMHC)

Department of Transportation (Caltrans)

Department of Insurance (DOI)

Franchise Tax Board (FTB)

State Controller’s Office (Unclaimed Property)

Other…

(Please specify)

Brief Description of Your Issue/Request (Please include details of the issue you’re facing, including relevant dates, case numbers, or correspondence)

Have you already attempted to resolve this issue?

Yes

If yes, what steps have you taken so far? (Please provide any details or actions you’ve already taken, such as contacting the agency or filing a claim/complaint)

Have you contacted another elected official?

Yes

Leave this field blank

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Contact

Capitol Office
P.O. Box 942849
Sacramento, CA 94249-0040
(916) 319-2040

District Office
27441 Tourney RD Suite 240
Santa Clarita, CA 91355
(661) 286-1565