NA10003_10004highlightedchanges

The following changes were made to the Privacy Act paragraphs on each of these two (2) forms:

NA 10003 (6-10)

In accordance with the Privacy Act of 1974 as amended, I hereby authorize the Office of Government Information Services to make inquiries on my behalf, including the right to review all documentation that OGIS deems necessary in connection with my request for assistance regarding the Freedom of Information Act and/or Privacy Act request/administrative appeal that I have referenced above. I understand that any documents I provide to OGIS may be copied and forwarded to officials of the referenced agency as a part of the mediation/resolution process. I also authorize any Federal department, agency or component to release information and records related to my Freedom of Information Act and/or Privacy Act request/administrative appeal to OGIS.

NA 10003 (4-11)

In accordance with the Privacy Act of 1974 as amended, I hereby authorize the Office of Government Information Services to make inquiries on my behalf, including the right to review all documentation that OGIS deems necessary regarding the Freedom of Information Act and/or Privacy Act request/administrative appeal that is the subject of my request for OGIS assistance. I understand that any documents I provide to OGIS, except those provided in confidence, may be copied and forwarded to officials of the referenced agency as a part of the mediation/resolution process. I also authorize any Federal department, agency or component to release to OGIS information and records related to my Freedom of Information Act and/or Privacy Act request/administrative appeal.

NA 10004 (6-10)

In accordance with the Privacy Act of 1974 as amended, I hereby authorize the Office of Government Information Services to make inquiries on my behalf, including the right to review all documentation that OGIS deems necessary in connection with my request for assistance regarding the Freedom of Information Act and/or Privacy Act request/administrative appeal that I have referenced above. I understand that any documents I provide to OGIS may be copied and forwarded to officials of the referenced agency as a part of the mediation/resolution process. I also authorize any Federal department, agency or component to release information and records related to my Freedom of Information Act and/or Privacy Act request/administrative appeal to OGIS.

NA 10004 (4-11)

In accordance with the Privacy Act of 1974 as amended, I hereby authorize the Office of Government Information Services to make inquiries on my behalf, including the right to review all documentation that OGIS deems necessary regarding the Freedom of Information Act and/or Privacy Act request/administrative appeal that is the subject of my request for OGIS assistance. I understand that any documents I provide to OGIS, except those provided in confidence, may be copied and forwarded to officials of the referenced agency as a part of the mediation/resolution process. I also authorize any Federal department, agency or component to release to OGIS information and records related to my Freedom of Information Act and/or Privacy Act request/administrative appeal.