Data Request Form printable pdf download

Data Request Form

DATA REQUEST FORM – DATA SUBJECTS

Date of request:

______________________

I am requesting access to data in the following way:

Note: Inspection is free, but MnDOT may charge for copies when the cost is over $10.00.

Inspection

Copies

Both Inspection and Copies

These are the data I am requesting:

Note: Describe the data you are requesting as specifically as possible. If you need more space, please use the

back of this form.

Contact Information

Data Subject Name: ________________________________________________________________________

Parent/Guardian name (if applicable)__________________________________________________________

Address: _________________________________________________________________________________

Phone number: _______________________ Email address: _______________________________________

Staff Verification

Identification provided ______________________________________________________________

MnDOT will respond to your request within 10 business days.

February 2016

Data Request Form