osd/js requester service center

FOIA Appeal Form

If you are requesting personal information about or for another individual, you must furnish a signed authorization from that individual granting you the third-party access to this information. Since this form does not accept attachments, such requests must be mailed.

Name (first, last e.g. John Doe)
Phone No.
E-mail Address
Organization
Address Line 1
Address Line 2
City
State
Zip Code
Province / Region / Territory
Post Code
Country
Requester Control No. (if applicable)
Office Processing Initial Request
FOIA Control Number
YOUR APPEAL:
Should it be necessary, upon evaluating your request, that complex research and extensive consultation efforts will result. Please click here to see our Fee Waiver Guidance or please indicate the fees you would be willing to pay for below:
Willing to Pay $25 Willing to Pay $50 Willing to Pay $100 Other Amount $
Privacy Act Request Instructions: If you are seeking records on yourself or your minor child(ren) (under 18), you must select the following declaration attesting to your identity:
"I declare under penalty of perjury that I am and that the statements contained in this document are true and correct."

Portable Document Format (PDF) files may be viewed with a free copy of Adobe Acrobat® Reader™.

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