FOIA Request Your Records

To get your records copy and paste fill in necessary parts

Your address
Daytime phone number

Date

FOIA/Privacy Act Office

Agency
Address

FOIA/Privacy Act Request

Dear FOIA/PA Officer:

Pursuant to both the Freedom of Information Act, 5 U.S.C. § 552, and the Privacy Act, 5 U.S.C. § 552a, I seek access to and copies of all records about me which you have in your possession.

To assist with your search for these records, I am providing the following additional information about myself: full name, Social Security number, date and place of birth. (Here also list whatever additional personal data you don’t mind revealing to the agency, such as other names used, former places of residence, foreign travel, government and other employment, political activities, etc.)

If you determine that any portions of these documents are exempt under either of these statutes, I will expect you to release the non-exempt portions to me as the law requires. I reserve the right to appeal any decision to withhold information.

I agree to pay reasonable fees incurred in the copying of these documents up to the amount of $(amount). If the estimated fees will be greater than that amount, please contact me by telephone before such expenses are incurred.

If you have any questions regarding this request, please contact me by telephone. Thank you for your assistance. I will look forward to receiving your prompt reply.

Very truly yours,

Your signature

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