Freedom Of Information / Privacy Act Record Request Form - Opm

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FREEDOM OF INFORMATION / PRIVACY ACT RECORD REQUEST FORM
Form Approved
OMB No. 3206-0259
Instructions: Use of this form is optional. You may use any written format for a Freedom of Information (FOIA)
or Privacy Act (PA) Request as long as it contains a description of the information you are requesting and
sufficient personally identifying data when required. Failure to provide the required information may result in
no action being taken on the request. Submit completed forms via fax, mail, or e-mail as scanned attachments.
If submitting via e-mail, you should ensure that the security of your e-mail system is adequate for transmitting
sensitive information before choosing to transmit your request, which contains your personally identifiable
information. Mail: OPM-Federal Investigative Services; ATTN: FOI/PA office, 1137 Branchton Road, P.O. Box 618,
Boyers, PA 16018. Fax: (724) 794-4590. e-Mail: FISFOIPARequests@opm.gov.
1. Type of Request
- (This section must be completed.)
PA/FOIA Request:
I request my own records. (Requester must complete sections 2, 3, 4, 5, and 7.)
FOIA Request:
I am making a request for records about someone or something other than myself.
(Requester must complete sections 2, 3, 7, and 8.)
PA Amendment Request:
I wish to amend my own records. In accordance with 5 C.F.R. § 297.301, the burden of proof rests with the record subject to illustrate
how his/her record is not accurate, timely, relevant, or complete. Requesters should attach additional material to this form.
(Requester must complete sections 2, 4, 5, and 7.)
2. Requester Information
- (This section must be completed.)
Full Name:
Street Address:
City:
State:
Zip Code:
Country:
e-Mail Address:
Secure e-Mail*
Preferred Delivery Method:
Hardcopy Mail
Optional:
Telephone Number:
*A secure e-mail ensures that the information being sent to you is encrypted and therefore cannot be intercepted and read. Many widely used e-mail providers
accept this type of file. If your e-mail provider prohibits secure e-mails you will be notified to register with the OPM server. This registration process will
authenticate your identity and will allow the e-mail to be delivered directly to you.
3. Records Requested (Select One)
Standard Form Only (SF86, 85P, or 85)
Most Recent Investigation, including Standard Form
Other (Specify in the box below) - Attach a separate page if you need more space than
All Investigations and Standard Forms
provided below.
INV 100
U.S. Office of Personnel Management
Page 1 of 3
Sept 2015
Federal Investigative Services

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