Share Your Story

ACA uses these testimonials on issues in our documentation to Congress and the Administration and also for potential use or insertion into the Congressional Record, news reports and/or other media accessible to the public.

ACA may also forward your issue to contacts in the US Government offices administering government programs (ex. Medicare Administration, Social Security Administration, State Department) asking for further information or clarification.

If you wish to share your personal issue or testimonial please fill out the form below.

Personal stories will not be edited by ACA.  You should not include personal information in your story if you do not want it made public.

Waiver and Indemnity.
By submitting my story/testimonial I hereby instruct and authorize ACA to distribute all details of my Personal Statement to such news and governmental organizations as ACA may deem appropriate. I expressly waive all claims and rights I may have in relation to the confidential nature of the details in the Personal Statement, and agree to fully indemnify ACA against all liabilities, expenses and claims which may arise as a result of such distribution. Delaware law (exclusive of its conflicts of laws provisions) shall apply. All disputes shall be resolved solely and exclusively in the Courts of the State of Delaware, and the parties consent to and agree to personal jurisdiction in such Courts.