FOIA Request Form (copy & paste & print: one page)

FOIA Request Form

Requester's Name: __________________________________________________ ____________________________

Address: __________________________________________________ ____________________________
__________________________________________________ ____________________________

Phone Number (optional): __________________________________________________ ____________________________

Fax Number (optional): __________________________________________________ ____________________________

E-Mail (optional): __________________________________________________ ____________________________

Subject: __________________________________________________ ____________________________
__________________________________________________ ____________________________

In order to help to determine status to assess fees, select:

_ An individual seeking information for personal use
_ Affiliated with an educational or noncommercial institution, and this request is made for a scholarly purpose
_ Affiliated with a private corporation and seeking information for use in the company's business
_ A representative of the news media and this request is made part of news gathering and not for commercial use

Enter media name: __________________________________________________ ____________________________

Select type of Media:

_ Newspaper
_ Magazine
_ Television Station
_ Other

Purpose: __________________________________________________ ____________________________
__________________________________________________ ____________________________

Enter maximum amount you are willing to pay: $ __________________________________________________ ____________________________

Explanation for a request for a waiver of fees: __________________________________________________ ____________________________
__________________________________________________ ____________________________

Additional Comments: __________________________________________________ ____________________________
__________________________________________________ ____________________________

This form cannot be used for Privacy Act requests or requests for information about a third party.

Re: Freedom of Information Act Request

Dear ___________________:

This is a request under the Freedom of Information Act, 5 U.S.C. Sec. 552.

I request that a copy of the following documents [or documents containing the following information] be provided to me: [identify the documents or information as specifically as possible].

In order to help to determine my status to assess fees, you should know that I am [insert a suitable description of the requester and the purpose of the request].

[Sample requester descriptions:

--a representative of the news media affiliated with (a newspaper, magazine, television station, etc., or a public interest organization that publishes or disseminates information, etc.), and this request is made as part of news gathering and not for a commercial use.

--affiliated with an educational or noncommercial scientific institution, and this request is made for a scholarly or scientific purpose and not for a commercial use.

--an individual seeking information for personal use and not for a commercial use.

--affiliated with a private corporation and am seeking information for use in the company's business.]

[Optional] I am willing to pay fees for this request up to a maximum of $[ ]. If you estimate that the fees will exceed this amount, please inform me first.

[Optional] I request a waiver of all fees for this request. Disclosure of the requested information to me is in the public interest because it is likely to contribute significantly to public understanding of the operations or activities of the government and is not primarily in my commercial interest. [Include a specific explanation.]

Thank you for your consideration of this request.

Sincerely,



Name
Address
City, State, Zip Code
Telephone Number [optional]

[from http://www.nist.gov/admin/foia/foia.htm]