FOIA Request Form

Your Contact Information:

Your Name*:

Street Address*:

City*:

State or Country*:

Zip or Postal Code*:

Organization (if applicable):

Address Type:

Home

Business

Daytime Phone Number* :

Request on behalf of another party:

No

Yes

Fax Number:

Your E-mail Address:

(Providing an e-mail address allows DOI and its bureaus/offices to communicate with you electronically when appropriate. It will also ensure that receive an e-mail confirmation of our receipt of your request.)

If so, which party:

Your Request:

Bureau/Office*:

Please select which bureau or office you would like to receive your request.

Please describe the information you are seeking so that an employee familiar with the subject area of the request may locate existing record(s) with a reasonable amount of effort. Include descriptive information, time frame to be searched, etc. In order for a record to be considered subject to your FOIA request, it must be in the bureau's or office's possession and control at the time the bureau or office begins its search for responsive records.

Request Description*:

Desired Format of Disclosure:

Please indicate your desired record format.

Expedited Processing:

A request for expedited processing must set forth the reasons why the request should be expedited. You must certify that the reasons given for seeking expedited processing of this request are true and correct to the best of your knowledge and belief. The action Bureau/Office will notify you of its decision whether to grant expedited processing within ten days after receiving the certified request. If the Bureau/Office denies the request for expedited processing, you will be advised of your right to submit an administrative appeal, which will be handled expeditiously. A reporting or court deadline is not a sufficient justification.

Select the applicable reason why you are requesting expedited processing:

There is an imminent threat to the life or physical safety of an individual.

There is an urgency to inform the public concerning actual or alleged Federal government activity.

Justification:

You MUST provide a justification statement if you have requested expedited processing.

Certification

I certify that the above statement(s) concerning expedited processing are true and correct to the best of my knowledge and belief.

Fees and Waivers

Please be advised that by making a FOIA request, it shall be considered an agreement by you to pay all applicable fees unless you have been granted a fee waiver. We will confirm this agreement in our acknowledgement letter.

Please select the appropriate statement:

In order to assist you in determining my requester category to assess fees, you should know that I am:

a representative of the news media and this request is made as part of a news gathering effort and not for commercial use

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 commercial use

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

News Media/ Educational or Noncommercial Scientific Institution Affiliation:

If you are seeking a fee waiver, it is your responsibility to provide detailed information to support your request. If you do not submit sufficient justification, your fee waiver request will be denied.

Check the boxes to the right to confirm that you meet the Department's fee waiver criteria:

Disclosure of the information is in the public interest because it is likely to contribute significantly to public understanding of the operations or activities of the Government.

Disclosure of the information is not primarily in my commercial interest.

Detailed Fee Waiver Justification:

Please explain why your request for a waiver of fees or a reduction in fees is justified.

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.