To request assistance for an issue you are having with a state agency, please submit the following request form. Staff will follow up by email for additional information, if needed, and to provide updates. Due to the large volume of requests, please allow 5 business days before following up with our office.
So our office may better assist you, please confirm the best phone number at which to contact you. *
Which state agency do you need assistance with? *
Applicable Case/Application/Identification Number:
EDD Customer Account Number:
Date of Birth: *
Date of Application (if applicable)
Have you contacted the agency? *
When was the last time you received a correspondence from the agency?
Have you contacted another elected official? *
If yes, who have you contacted?
Please provide a detailed summary of the issue you are requesting assistance with. *
Does the Office of Assemblymember James Gallagher have permission to work with this agency on your behalf? *