FBI Seal

FOIA Request Form

Requester's Name: _________________________________________________________________________________________________________________________ 

Address: __________________________________________________________________________________________________________________________________
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Phone Number (optional): __________________________________________________________________________________________________________________

Fax Number (optional): ____________________________________________________________________________________________________________________

E-Mail (optional): __________________________________________________________________________________________________________________________

Subject: __________________________________________________________________________________________________________________________________
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In order to help to determine status to assess fees, select:

An individual seeking information for personal use
Affiliated with an educational or noncommercial institution, and this request is made for a scholarly purpose
Affiliated with a private corporation and seeking information for use in the company's business
A representative of the news media and this request is made part of news gathering and not for commercial use

 

Enter media name: _______________________________________________________________________________________________________________________

Select type of Media:

Newspaper
Magazine
Television Station
Other

Purpose: ________________________________________________________________________________________________________________________________
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Enter maximum amount you are willing to pay: $ ___________________________________________________________________________________________

Explanation for a request for a waiver of fees: _____________________________________________________________________________________________
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Additional Comments: __________________________________________________________________________________________________________________
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This form cannot be used for Privacy Act requests or requests for information about a third party.