This letter is useful for requesting public information from an agency of the U.S. government.  Do not use this form for requesting personal information about yourself.  The Privacy Act Request For Documents is used for that.

Our thanks go to attorney Robert Clarkson (now deceased) for providing this form.

You should send your FOIA/Privacy Act  request to the address you locate on the following website:

http://www.irs.gov/prod/preview/foia/offices.html

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FREEDOM OF INFORMATION ACT REQUEST

TO:

____________________________ ____________________________ ____________________________ ____________________________

FROM:

____________________________ ____________________________ ____________________________ ____________________________

1.      This is a request under the Freedom of Information Act, 5 U.S.C. §552 and the Privacy Act, 5 U.S.C. §552a. I agree to pay costs and fees of locating and copying the documents requested below.

2.      This request is in the public interest because the requested materials pertain to the public at large and not to any particular person. Also, my funds are limited and I may be a person eligible to receive federal benefits.Therefore, I request that you waive fees and costs, but if you do not, please send the requested materials and do not let the request for waiver delay this FOIA request.You can consider this a firm agreement to pay fees. I request fee waiver because no commercial use is intended and disclosure will contribute to public understanding of the activities of the government.

3.      If some of my requests are exempt from release, send me those portions “reasonably segregatable,” and provide me with an indexing, itemization and detailed justification concerning information which you are not releasing.

4.      Please send me the following documents:

Date:____________                    _______________________________________

                                                                                                       Requester