FOIA Request Form
Note: Privacy Act requests must be submitted in writing in accordance with instructions in the Privacy Act notice. The Privacy Act Officer may require you to submit a signed and notarized statement indicating that you are the individual to whom the records pertain and that you understand it is a misdemeanor punishable by a fine up to $5,000 to knowingly and willfully seek or obtain records about another individual under false pretenses.
PRIVACY ACT ADVISORY
Regulations at 43 CFR, Part 2 authorize the collection of this information. It is protected by Privacy Act Systems of Records Notice DOI—71: "Freedom of Information Request Files System—Interior" (57 FR 58817-58819).
The information you provide is used by Bureau/Office FOIA Offices to respond to your request for agency documents. Disclosures of this information within the Department may be made to program offices within the Bureau/Office to locate the documents you are seeking, to legal counsel, others within the agency to review the Bureau's/Office's proposed response to your request, and to any other parties within the agency with a need-to-know interest in your FOIA request.
Disclosures of this information may also be made outside the Department to parties for purposes detailed in the Routine Uses section of Privacy Act System of Records Notice DOI—71.