Agency Service Constituent Profile form

  • Release version: Washingtondc
  • Updated February 1, 2024
  • 2 minutes to read

    • Use the Agency Service Constituent Profile form in the Public Sector Digital Services application to display detailed information about a constituent, such as the name and address, date of birth, contact information, and language choice.

    The following table describes the detailed information that you can add to the Agency Service Constituent form.

    Table 1. Agency Service Constituent form
    Field Description
    Consumer reference Reference number for the constituent case.
    First name First name.
    Last name Last name.
    Middle name Middle name.
    Number Phone number of the constituent.
    Suffix Suffix of the constituent name. The suffix may include MD or Jr.
    Mobile phone Mobile phone number for the constituent.
    Business phone Business phone number for the constituent.
    Fax Fax number.
    Photo Photo of the constituent.
    Email Email of the constituent.
    Gender Gender of the constituent.
    Date of birth Date of birth of the constituent.
    Country of birth Country of birth of the constituent.
    Age Age of the constituent.
    Identification Information
    Primary identification type Type of primary identification:
    • Social Security Number
    • State Identification Number
    • Drivers License Number
    • Medicare ID
    Identification field Type of identification. This field appears only when an option is selected from the Primary identification type field.
    • Social Security Number
    • State Identification Number
    • Drivers License Number
    • Medicare ID
    Primary correspondence Information
    Primary address type Type of primary address for the constituent:
    • Home address
    • Business address
    • Mailing address
    Street Street of the constituent.
    City City that the constituent lives in.
    State/Province State in which the constituent lives.
    ZIP/Postal code ZIP code for the address of the constituent.
    Latitude Latitude of the address of the constituent.
    Longitude Longitude of the address of the constituent.
    Primary phone number Primary phone number of the constituent.
    Additional information
    Marital status
    • Married
    • Single
    • Divorced
    • Widowed
    • I do not wish to provide this information
    Employment status
    • Employed
    • Unemployed
    • Self employed
    • I do not wish to provide this information
    Race
    • American Indian or Alaska Native
    • Asian
    • Native Hawaiian or other Pacific Islander
    • Black or African American
    • White
    • I do not wish to provide this information
    Ethnicity
    • Hispanic or Latino
    • Not Hispanic or Latino
    • I do not wish to provide this information
    Military status
    • Active duty
    • Veteran
    • No military duty
    • I do not wish to provide this information
    Disability status
    • Yes, I have a disability
    • No, I do not have a disability
    • I do not wish to provide this information
    Highest education level
    • High school or equivalent
    • Technical or occupational certificate
    • Associate degree
    • Some college coursework completed
    • Bachelor's degree
    • Master's degree
    • Doctorate
    • Professional
    • Other
    Primary language choice
    • English
    • Spanish
    Notes
    Notes Additional notes about the constituent or the case.