Legal & Compliance
FOIA Request Acknowledgment
Freedom of Information Act request acknowledgment and processing agreement. Single signer (requester).
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# Freedom of Information Act Request Acknowledgment **Date of Request:** ___________ This FOIA Request Acknowledgment ("Acknowledgment") is submitted by: **Requester:** ___________ **Email:** ___________ **Mailing Address:** ___________ **Phone Number:** ___________ ## 1. Agency Information **Agency Name:** ___________ **Agency Department/Office:** ___________ **FOIA Officer (if known):** ___________ ## 2. Records Requested **Description of Records Sought:** ___________ **Date Range of Records:** From ___________ to ___________ **Format Preference:** ___________ ## 3. Fee Category The Requester identifies as the following fee category under 5 U.S.C. Section 552(a)(4)(A): ___________ ## 4. Fee Waiver Request ___________
Fields (22)
request date
date · required
requester name
text · required
requester email
text · required
requester address
textarea · required
requester phone
text
agency name
text · required
agency department
text · required
foia officer
text
records description
textarea · required
records start date
date · required
records end date
date · required
format preference
select · required
fee category
select · required
fee waiver
select · required
fee waiver justification
textarea
max fee
text · required
expedited processing
select · required
expedited justification
textarea
request purpose
select · required
purpose details
textarea
governing state
select · required
requester signer name
text · required
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