{"id":30900,"date":"2023-09-05T18:56:51","date_gmt":"2023-09-05T22:56:51","guid":{"rendered":"https:\/\/cortezmasto-staging.creativengine.com\/?page_id=30900"},"modified":"2023-09-05T19:00:45","modified_gmt":"2023-09-05T23:00:45","slug":"form","status":"publish","type":"page","link":"https:\/\/www.cortezmasto.senate.gov\/es\/help\/help-with-a-federal-agency\/social-security\/form\/","title":{"rendered":"Social Security Privacy Release Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"30900\" class=\"elementor elementor-30900\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-57ec02c e-flex e-con-boxed e-con e-parent\" data-id=\"57ec02c\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-98b3eee eael-gravity-form-button-custom elementor-widget elementor-widget-eael-gravity-form\" data-id=\"98b3eee\" data-element_type=\"widget\" data-widget_type=\"eael-gravity-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t            <div class=\"eael-contact-form eael-gravity-form eael-contact-form-align-default\">\n                                <script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_24' >\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_24'  action='\/es\/wp-json\/wp\/v2\/pages\/30900' data-formid='24' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_24' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_24_1\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_1\" ><h3 class=\"gsection_title\">Contact Information<\/h3><\/div><div id=\"field_24_3\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_3\" ><label class='gfield_label gform-field-label' for='input_24_3'>Prefix<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_24_3' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>--<\/option><option value='Mr.' >Mr.<\/option><option value='Ms.' >Ms.<\/option><option value='Mrs.' >Mrs.<\/option><option value='Prefer not to identify' >Prefer not to identify<\/option><option value='Professor' >Professor<\/option><option value='Dr.' >Dr.<\/option><option value='Father' >Father<\/option><option value='Sister' >Sister<\/option><option value='Rabbi' >Rabbi<\/option><option value='Reverend' >Reverend<\/option><option value='Air Force - General' >Air Force - General<\/option><option value='Air Force - Lieutenant General' >Air Force - Lieutenant General<\/option><option value='Air Force - Major General' >Air Force - Major General<\/option><option value='Air Force - Brigadier General' >Air Force - Brigadier General<\/option><option value='Air Force - Colonel' >Air Force - Colonel<\/option><option value='Air Force - Lieutenant Colonel' >Air Force - Lieutenant Colonel<\/option><option value='Air Force - Major' >Air Force - Major<\/option><option value='Air Force - Captain' >Air Force - Captain<\/option><option value='Air Force - First Lieutenant' >Air Force - First Lieutenant<\/option><option value='Air Force - Second Lieutenant' >Air Force - Second Lieutenant<\/option><option value='Air Force - Chief Master Sergeant of the Air Force' >Air Force - Chief Master Sergeant of the Air Force<\/option><option value='Air Force - Command Chief Master Sergeant' >Air Force - Command Chief Master Sergeant<\/option><option value='Air Force - First Sergeant (E-9)' >Air Force - First Sergeant (E-9)<\/option><option value='Air Force - Chief Master Sergeant' >Air Force - Chief Master Sergeant<\/option><option value='Air Force - First Sergeant (E-8)' >Air Force - First Sergeant (E-8)<\/option><option value='Air Force - Senior Master Sergeant' >Air Force - Senior Master Sergeant<\/option><option value='Air Force - First Sergeant (E-7)' >Air Force - First Sergeant (E-7)<\/option><option value='Air Force - Master Sergeant' >Air Force - Master Sergeant<\/option><option value='Air Force - Technical Sergeant' >Air Force - Technical Sergeant<\/option><option value='Air Force - Staff Sergeant' >Air Force - Staff Sergeant<\/option><option value='Air Force - Senior Airman' >Air Force - Senior Airman<\/option><option value='Air Force - Airman First Class' >Air Force - Airman First Class<\/option><option value='Air Force - Airman' >Air Force - Airman<\/option><option value='Air Force - Airman Basic' >Air Force - Airman Basic<\/option><option value='Army - General' >Army - General<\/option><option value='Army - Lieutenant General' >Army - Lieutenant General<\/option><option value='Army - Major General' >Army - Major General<\/option><option value='Army - Brigadier General' >Army - Brigadier General<\/option><option value='Army - Colonel' >Army - Colonel<\/option><option value='Army - Lieutenant Colonel' >Army - Lieutenant Colonel<\/option><option value='Army - Major' >Army - Major<\/option><option value='Army - Captain' >Army - Captain<\/option><option value='Army - First Lieutenant' >Army - First Lieutenant<\/option><option value='Army - Second Lieutenant' >Army - Second Lieutenant<\/option><option value='Army - Chief Warrant Officer - 5' >Army - Chief Warrant Officer - 5<\/option><option value='Army - Chief Warrant Officer - 4' >Army - Chief Warrant Officer - 4<\/option><option value='Army - Chief Warrant Officer - 3' >Army - Chief Warrant Officer - 3<\/option><option value='Army - Chief Warrant Officer - 2' >Army - Chief Warrant Officer - 2<\/option><option value='Army - Warrant Officer' >Army - Warrant Officer<\/option><option value='Army - Sergeant Major of the Army' >Army - Sergeant Major of the Army<\/option><option value='Army - Command Sergeant Major' >Army - Command Sergeant Major<\/option><option value='Army - Sergeant Major' >Army - Sergeant Major<\/option><option value='Army - First Sergeant' >Army - First Sergeant<\/option><option value='Army - Master Sergeant' >Army - Master Sergeant<\/option><option value='Army - Sergeant First Class' >Army - Sergeant First Class<\/option><option value='Army - Staff Sergeant' >Army - Staff Sergeant<\/option><option value='Army - Sergeant' >Army - Sergeant<\/option><option value='Army - Corporal' >Army - Corporal<\/option><option value='Army - Specialist' >Army - Specialist<\/option><option value='Army - Private First Class' >Army - Private First Class<\/option><option value='Army - Private (E-2)' >Army - Private (E-2)<\/option><option value='Army - Private' >Army - Private<\/option><option value='Coast Guard - Admiral' >Coast Guard - Admiral<\/option><option value='Coast Guard - Vice Admiral' >Coast Guard - Vice Admiral<\/option><option value='Coast Guard - Rear Admiral, Upper Half' >Coast Guard - Rear Admiral, Upper Half<\/option><option value='Coast Guard - Rear Admiral, Lower Half' >Coast Guard - Rear Admiral, Lower Half<\/option><option value='Coast Guard - Captain' >Coast Guard - Captain<\/option><option value='Coast Guard - Commander' >Coast Guard - Commander<\/option><option value='Coast Guard - Lieutenant Commander' >Coast Guard - Lieutenant Commander<\/option><option value='Coast Guard - Lieutenant' >Coast Guard - Lieutenant<\/option><option value='Coast Guard - Lieutenant Junior Grade' >Coast Guard - Lieutenant Junior Grade<\/option><option value='Coast Guard - Ensign' >Coast Guard - Ensign<\/option><option value='Coast Guard - Chief Warrant Officer - 4' >Coast Guard - Chief Warrant Officer - 4<\/option><option value='Coast Guard - Chief Warrant Officer - 3' >Coast Guard - Chief Warrant Officer - 3<\/option><option value='Coast Guard - Chief Warrant Officer - 2' >Coast Guard - Chief Warrant Officer - 2<\/option><option value='Coast Guard - Master Chief Petty Officer of the Coast Guard' >Coast Guard - Master Chief Petty Officer of the Coast Guard<\/option><option value='Coast Guard - Master Chief Petty Officer' >Coast Guard - Master Chief Petty Officer<\/option><option value='Coast Guard - Senior Chief Petty Officer' >Coast Guard - Senior Chief Petty Officer<\/option><option value='Coast Guard - Chief Petty Officer' >Coast Guard - Chief Petty Officer<\/option><option value='Coast Guard - Petty Officer First Class' >Coast Guard - Petty Officer First Class<\/option><option value='Coast Guard - Petty Officer Second Class' >Coast Guard - Petty Officer Second Class<\/option><option value='Coast Guard - Petty Officer Third Class' >Coast Guard - Petty Officer Third Class<\/option><option value='Coast Guard - Seaman' >Coast Guard - Seaman<\/option><option value='Coast Guard - Seaman Apprentice' >Coast Guard - Seaman Apprentice<\/option><option value='Coast Guard - Seaman Recruit' >Coast Guard - Seaman Recruit<\/option><option value='Marine Corps - General' >Marine Corps - General<\/option><option value='Marine Corps - Lieutenant General' >Marine Corps - Lieutenant General<\/option><option value='Marine Corps - Major General' >Marine Corps - Major General<\/option><option value='Marine Corps - Brigadier General' >Marine Corps - Brigadier General<\/option><option value='Marine Corps - Colonel' >Marine Corps - Colonel<\/option><option value='Marine Corps - Lieutenant Colonel' >Marine Corps - Lieutenant Colonel<\/option><option value='Marine Corps - Major' >Marine Corps - Major<\/option><option value='Marine Corps - Captain' >Marine Corps - Captain<\/option><option value='Marine Corps - First Lieutenant' >Marine Corps - First Lieutenant<\/option><option value='Marine Corps - Second Lieutenant' >Marine Corps - Second Lieutenant<\/option><option value='Marine Corps - Chief Warrant Officer - 5' >Marine Corps - Chief Warrant Officer - 5<\/option><option value='Marine Corps - Chief Warrant Officer - 4' >Marine Corps - Chief Warrant Officer - 4<\/option><option value='Marine Corps - Chief Warrant Officer - 3' >Marine Corps - Chief Warrant Officer - 3<\/option><option value='Marine Corps - Chief Warrant Officer - 2' >Marine Corps - Chief Warrant Officer - 2<\/option><option value='Marine Corps - Warrant Officer' >Marine Corps - Warrant Officer<\/option><option value='Marine Corps - Sergeant Major of the Marine Corps' >Marine Corps - Sergeant Major of the Marine Corps<\/option><option value='Marine Corps - Sergeant Major' >Marine Corps - Sergeant Major<\/option><option value='Marine Corps - Master Gunnery Sergeant' >Marine Corps - Master Gunnery Sergeant<\/option><option value='Marine Corps - First Sergeant' >Marine Corps - First Sergeant<\/option><option value='Marine Corps - Master Sergeant' >Marine Corps - Master Sergeant<\/option><option value='Marine Corps - Gunnery Sergeant' >Marine Corps - Gunnery Sergeant<\/option><option value='Marine Corps - Staff Sergeant' >Marine Corps - Staff Sergeant<\/option><option value='Marine Corps - Sergeant' >Marine Corps - Sergeant<\/option><option value='Marine Corps - Corporal' >Marine Corps - Corporal<\/option><option value='Marine Corps - Lance Corporal' >Marine Corps - Lance Corporal<\/option><option value='Marine Corps - Private First Class' >Marine Corps - Private First Class<\/option><option value='Marine Corps - Private' >Marine Corps - Private<\/option><option value='Navy - Admiral' >Navy - Admiral<\/option><option value='Navy - Vice Admiral' >Navy - Vice Admiral<\/option><option value='Navy - Rear Admiral, Upper Half' >Navy - Rear Admiral, Upper Half<\/option><option value='Navy - Rear Admiral, Lower Half' >Navy - Rear Admiral, Lower Half<\/option><option value='Navy - Captain' >Navy - Captain<\/option><option value='Navy - Commander' >Navy - Commander<\/option><option value='Navy - Lieutenant Commander' >Navy - Lieutenant Commander<\/option><option value='Navy - Lieutenant' >Navy - Lieutenant<\/option><option value='Navy - Lieutenant Junior Grade' >Navy - Lieutenant Junior Grade<\/option><option value='Navy - Ensign' >Navy - Ensign<\/option><option value='Navy - Chief Warrant Officer - 4' >Navy - Chief Warrant Officer - 4<\/option><option value='Navy - Chief Warrant Officer - 3' >Navy - Chief Warrant Officer - 3<\/option><option value='Navy - Chief Warrant Officer - 2' >Navy - Chief Warrant Officer - 2<\/option><option value='Navy - Master Chief Petty Officer of the Navy' >Navy - Master Chief Petty Officer of the Navy<\/option><option value='Navy - Master Chief Petty Officer' >Navy - Master Chief Petty Officer<\/option><option value='Navy - Senior Chief Pretty Officer' >Navy - Senior Chief Pretty Officer<\/option><option value='Navy - Chief Petty Officer' >Navy - Chief Petty Officer<\/option><option value='Navy - Petty Officer First Class' >Navy - Petty Officer First Class<\/option><option value='Navy - Petty Officer Second Class' >Navy - Petty Officer Second Class<\/option><option value='Navy - Petty Officer Third Class' >Navy - Petty Officer Third Class<\/option><option value='Navy - Seaman Apprentice' >Navy - Seaman Apprentice<\/option><option value='Navy - Seaman' >Navy - Seaman<\/option><option value='Navy - Seaman Recruit' >Navy - Seaman Recruit<\/option><\/select><\/div><\/div><div id=\"field_24_5\" class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_5\" ><label class='gfield_label gform-field-label' for='input_24_5'>First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_24_5' type='text' value='' class='large'    placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_24_7\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_7\" ><label class='gfield_label gform-field-label' for='input_24_7'>MI<\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_24_7' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_24_6\" class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_6\" ><label class='gfield_label gform-field-label' for='input_24_6'>Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_24_6' type='text' value='' class='large'    placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_24_8\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_8\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_24_8' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_24_8_1_container' >\n                                        <label for='input_24_8_1' id='input_24_8_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_8.1' id='input_24_8_1' value=''   placeholder='Required' aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_24_8_2_container' >\n                                        <label for='input_24_8_2' id='input_24_8_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_8.2' id='input_24_8_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_24_8_3_container' >\n                                    <label for='input_24_8_3' id='input_24_8_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_8.3' id='input_24_8_3' value=''   placeholder='Required' aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_24_8_4_container' >\n                                        <label for='input_24_8_4' id='input_24_8_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_8.4' id='input_24_8_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' selected='selected'>Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_24_8_5_container' >\n                                    <label for='input_24_8_5' id='input_24_8_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_8.5' id='input_24_8_5' value=''   placeholder='Required' aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_8.6' id='input_24_8_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><fieldset id=\"field_24_9\" class=\"gfield gfield--type-email gfield--width-full EmailConfirmationRow gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_9\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_24_9_container'>\n                                <span id='input_24_9_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_9' id='input_24_9' value=''   placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_24_9' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_24_9_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_9_2' id='input_24_9_2' value=''   placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_24_9_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_24_12\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_12\" ><label class='gfield_label gform-field-label' for='input_24_12'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_12' id='input_24_12' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_24_12_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_24_12_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_24_12' class='gform_hidden' value='https:\/\/www.cortezmasto.senate.gov\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_24_11\" class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_11\" ><label class='gfield_label gform-field-label' for='input_24_11'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_24_11' type='text' value='' class='large'    placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_24_13\" class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_13\" ><label class='gfield_label gform-field-label' for='input_24_13'>Social Security Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_24_13' type='text' value='' class='large'    placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_24_14\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_14\" ><h3 class=\"gsection_title\">Social Security Information<\/h3><\/div><div id=\"field_24_15\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_15\" ><label class='gfield_label gform-field-label' for='input_24_15'>What type of SSA benefits are you inquiring on?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_24_15' type='text' value='' class='large'    placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_24_16\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_16\" ><label class='gfield_label gform-field-label' for='input_24_16'>Claim\/Reference number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_24_16' type='text' value='' class='large'    placeholder='Required' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_24_18\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_18\" ><label class='gfield_label gform-field-label' for='input_24_18'>Is this matter pending before a court of law or Administrative Law Judge?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_18' id='input_24_18' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>--<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/div><div id=\"field_24_19\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_19\" ><label class='gfield_label gform-field-label' for='input_24_19'>Brief description of the issue<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_19' id='input_24_19' class='textarea large'   maxlength='500'  aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_24_20\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_20\" ><p>Please review all the information above carefully before submitting. Once you sign and date below, please hit the \"submit\" button below, then again on the confirmation page so my office can begin assisting you.<\/p>\n<p>Please print document and add your signature. You are welcomed to mail the document to the closest office, by email at <a href=\"mailto:casework@cortezmasto.senate.gov\">Casework@cortezmasto.senate.gov<\/a>, or by fax at 702-388-5030.<\/p><\/div><div id=\"field_24_21\" class=\"gfield gfield--type-captcha gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_24_21\" ><label class='gfield_label gform-field-label' for='input_24_21'>CAPTCHA<\/label><div id='input_24_21' class='ginput_container ginput_recaptcha' data-sitekey='6LfO9xkoAAAAACsdYG1H8Z5_J3Ua4oPdKFIQqrK_'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_24' class='gform_button button' onclick='gform.submission.handleButtonClick(this)' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_24' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_24' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='24' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_24' 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