Postmaster                                      Date:

City, State, Zip Code-9998


Dear Postmaster:


Address Information Request


Please furnish this agency with the new address, if available, for the following individual or verify whether or not the address given below is one at which mail for this individual is currently being delivered.  If the following address is a post office box, please furnish the street address as recorded on the box-holder’s application form.


Full Name:              Claimant/Authorized Representative


Last Known Address:     Number/Street Name

                        City, State, Zip Code


I certify that the address information for this individual is required for the performance of this agency’s official duties.



Signature of Agency Official





* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *



___ Mail is delivered to address given     New Address:

___ Not known at address given          ________________________

___ Moved, left no forwarding address   ________________________

___ No such address                     ________________________

___ Other: (Specify) ___________ 

________________________________    Box Holder’s Street Address:

________________________________    ____________________________

________________________________    ____________________________



USPS Return Address:                Postmark/Date Stamp


As per 39 USC 404…”the USPS does not disclose mailing information except in the following limited circumstances; Authorized disclosures include limited circumstances such as the following: (a) to other government agencies or bodies: when relevant to a decision concerning employment, security clearances, security or suitability investigations, contracts, licenses, grants or benefits”…


The correspondence in question fits within the aforementioned parameters and our agency is requesting the aforementioned information as formatted in the USPS Administrative Support Manual Section 352.44.  Please respond to our office via return mail or fax with the aforementioned postal patron’s new address/contact information.


If you have any questions regarding this letter, please call me at XXX-XXX-XXXX


Physical Address:       US Department of Labor – DEEOIC

Attn:  Printed Name

Number/Street Name

City, State, Zip Code


Fax Number:  XXX-XXX-XXXX   

Attn:  Printed Name






Printed Name