Agency Head (or FOIA Officer)
Name of agency
Address of Agency
City, State, Zip Code
Re: Freedom of Information Act Request--- put the subject of the request records here
This is a request under the Freedom of Information Act. I request that a copy of the following documents (or documents with the following types of information) be provided to me.
- Specify the documents you are requesting here with specificity.
- You can list additional categories, search terms, etc. in a list format.
To help determine my status for fee assessment, you should know that I am_______ (insert a description of who you are and the purpose of the request. For example, “an individual seeking information for personal use and not for commercial use” or “affiliate with an education institution and this request is made for a scholarly purpose.”) OR you can request a fee waiver here by stating “I request a waiver of all fees for this request. Disclosure of the requested information is in the public interest because ________.”
Thank you for your assistance.
[Your Name Here]