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Privacy Act Request Checklist

Please include the following information in your request:

• Title (for example: Dr, Miss, Mr, Mrs, Ms)
• Full name (required)
• Address (required)
• Daytime phone number (required)
• Description of requested records (required)
• Agency contacts
• Maximum dollar amount the requestor is willing to pay for the request (required)
• Request for a waiver of fees, if requested information is in the public interest because it is likely to contribute significantly to public understanding of the operations or activities of the government and is not primarily in your commercial interest.
• Explanation for a request for a waiver of fees (required if a waiver is requested)
• Statement signed under penalty of perjury stating that you are the person who you claim to be (required)
• Fax number
• Email address
• Attachment of supporting documents