You can request assistance by completing the inquiry form below or by calling our office at (866) 413-4911 . We review and respond to requests in the order they are received. It may take several weeks for an advocate to respond. You should note any deadlines.

By submitting this form, you understand that Legal Services of Northern California/the Western States Pension Assistance Project is not agreeing to represent you in any matter, or otherwise agreeing to take on your case.

Contact Information

Are you looking for help with a pension for yourself or for someone else (spouse, parent, etc.)?

What is the name of the person completing this form?

What is the best telephone number to reach you?

Please enter a valid phone number in the format (999) 999-9999.

What is your email address?

Please complete the remaining questions on this form for the person for whom you are requesting help.

First Name

Last Name

Street Address

City

State

Zip

Home Phone

Cell Phone

Work Phone

Other Phone

How did you hear about us?

Employer and Pension Information

Do you have pension employer information to provide?

YesNo

Pension Employer's Name

Street Address

Pension Plan Name

City

State

Zip

Dates of Employment

In no more than 1500 characters, please briefly describe the problem with the pension.

Personal Information

Marital Status

Type of Housing

How many people live in your household?

Estimated Monthly Household Income (Please enter a dollar amount))

What is your gender identity?

Add other gender information here

Primary Language:

Do you identify as a person with disabilities?

Disability description

Upload Files

Do you have pension-related notices you'd like to upload?

If you have pension-related notices, you may attach up to four here.

Contact Information