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Claim/Case Number: Do you have a claim pending with Medicare? If so, when was it filed? Brief description of problem (Please attach copies of all supporting documents): I authorize Congressman Bishop and his staff to receive any information that they may need in order to provide this assistance. / / Signature Date *Note: In order to comply with the provisions of the Privacy Act of 1974 and to be of assistance with claim(s), it is necessary that your signature be on file. Please print and ma.
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Congressman Tim Bishop : Home
Phone: (631) 259-8450. Fax: (631) 259-8451. View on map · Site Map · Contact · U.S...
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