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FOIA Request Submittal Form

Privacy Act Statement

Failure to enter complete information may result in the inability to process your FOIA request.

First Name: (Required)
Last Name: (Required)
Company/Affliation
Address 1: (Required)
Address 2:
City: (Required)
State: (Required)
Zip Code: (Required)
Country:	United States Other - Specify:
E-mail:
Phone:
Description of Records:

Fee categorization - Select the category that best describes you or your organization: (Required)

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

Enter media company name:

Select type of media:

Do Not fill out the following unless you are requesting expedited processing.
To request expedited processing check the appropriate box and provide an explanation:

	Failure to obtain requested records could reasonably be expected to pose an imminent threat to the life or physical safety of an individual.

	Request made by a person primarily engaged in disseminating information, urgency to inform the public concerning actual or alleged Federal Government activity.

Do Not fill out the following unless you are requesting a fee waiver.
To request for a fee waiver address each of the following eight criteria:

Describe the purpose for which you intend to use the requested information.

Explain the extent to which you will extract & analyze the substantive content of the records.

Describe the nature of the specific activity or research in which the records will be used & the specific qualifications you possess to utilize information for the intended use in such a way that it will contribute to public understanding.

Describe the likely impact on the public’s understanding of the subject as compared to the level of understanding of the subject existing prior to disclosure.

Describe the size & nature of the public to whose understanding a contribution will be made.

Describe the intended means of dissemination to the general public.

Indicate if public access to information will be provided free of charge or provided for an access fee or publication fee.

Describe any commercial or private interest you or any other party has in the agency records sought.