Agency Head [or Freedom of Information Act Officer]                   Date
Name of Agency
Address of Agency
City, State, Zip Code


Re: Freedom of Information Act Request


Dear FOIA Public Liasion: (Sir or Madam will also do)  

This is a request under the Freedom of Information Act, 5 U.S.C. Sec. 552.

I request that a copy of the following documents [or documents containing the following information] be provided to me: [identify the documents or information as specifically as possible].

In order to help to determine my status to assess fees, you should know that I am a representative of the news media affiliated with a public interest organization that publishes or disseminates information, and this request is made as part of news gathering and not for a commercial use.



[Optional] I am willing to pay fees for this request up to a maximum of $[ ]. If you estimate that the fees will exceed this amount, please inform me first.

[Optional] I request a waiver of all fees for this request. Disclosure of the requested information to me 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 my commercial interest. [Include a specific explanation.]

I also include a telephone number at which I can be contacted during the hours of ________, if necessary, to discuss any aspect of my request.
I look forward to your reply within 20 workdays (excluding Saturdays, Sundays, and legal holidays), as the statute requires.


Thank you for your consideration of this request.

Sincerely,
 
 

Name
Address
City, State, Zip Code
Telephone Number [optional]