Form UnNumbered E-FOIA

E-FOIA

1110-0053_form

E-FOIA

OMB: 1110-0053

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FBI eFOIA Request Form
The Freedom of Information Act allows any person - except fugitives, federal agencies, and foreign
intelligence agencies-to request information about organizations, businesses, investigations,
historical events, incidents, groups or deceased persons.
Instructions: Please use this form to make FOIA request only, This form should NOT be used to
make a request about yourself or another living person.
If your request is for information about another living person , that information is usually not
disclosed unless you have obtained the person's written consent or unless public disclosure is
authorized by law. Request for information about another living person should be accompanied
by evidence of the subjects consent. Please use the U. S. Department of Justice Certification of
Identity Form DOJ-361 and complete the section identified as Authorization to Release
Information to Another Person.
To make a written request please mail to:

FBI
Records Information Dissemination Section
Attn: FOI/PA request
170 Marcel Drive
Winchester, VA 22602-4843

Privacy Act Statement. In accordance with 28 CFR Section 16.3, personal data sufficient to
identify the individuals submitting requests under the Freedom of Information Act, as amended (5
U.S.C. Section 552) (FOIA), is required. The purpose of this solicitation is to ensure completed
responses to requests for records are mailed to the appropriate address. Disclosure is voluntary
and the use of this information will be used consistent with the routine uses published in
DOJ-004. Individuals who submit FOIA requests to the FBI do so with the understanding that
their identity as a FOIA requester may become a matter of public record because an agency's FOIA
activities, including the identity of entities making access requests, is subject to release pursuant
to the FOIA.

Part A. Requester Information
Current Date

* This is indicates a required field

Prefix:

First

*

Middle

Last

*

Suffix

*

Address 1
Address 2
Address 3
City

*

State

*

Zip Code

*

Country
Phone #1
E-mail Address

Part B . Request
Request: Please remember that you may only make a FOIA request using this form. this is not for request under the Privacy Act. Please provide as much
information as possible when completing this form. Providing detailed, accurate information regarding the request allows the FBI to conduct the most
accurate search possible. If your request is for information concerning a deceased individual, you must provide a proof of death. Acceptable forms of
proof of death include: obituaries, death certificates, recognized sources that can be documented, written media, an FBI file that indicates a person is
deceased, date of birth is 100 years old or greater, or the Social Security death Index Page. It is the duty of the requester to provide the proof of death for
a FOIA request.
If your request is for an entity/event please provide details of this entity/event in Section 2 of Part B. Please be very specific including dates, and
individuals involved. If these individuals are living a privacy waiver MUST be completed and this request can not be completed using this form.

Section 1
Prefix

Middle Name

First Name

Last Name

Suffix

SSN

ARN

FBI Number

Place of Birth

Date of Birth

Please provide any information that would assist the FBI in locating responsive records.
If your request has aliases please list these here.

Alias's
Detailes

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Section 2.

Are you making a request on something other than a deceased individual? If so, please give detailed information regarding the
organization, business, investigations, historical event, incident or, group. Please ONLY MAKE ONE FOIA REQUEST PER SUBMISSION. If
you have more than one subject matter you will need to complete additional eFOIA form(s). If you wish to attach further documentation
to explain your request, please use the upload attachment feature below.

Upload Attachment Browse

Part C. Fee Categories
Please check the appropriate fee category so that we may properly and accurately asses fees for your request.
I am an individual seeking information for personal use and not for commercial use.
I am a representative of the news media and I am seeking this information as part of a news gathering effort and
not for commercial use. Please list your affiliation.
Media Affiliation

I am affiliated with an educational or noncommercial scientific institution seeking information for a
scholarly or scientific purpose and not for commercial use. ( Additional documentation will be requiredPlease see 22CFR171.5(b) and provide this documentation)
I am affiliated with a private corporation and I am seeking information for use in the companies business.

Part C. Agreement to Pay
Agreement to pay fees: Please be advised that by making a FOIA request it shall be considered an agreement by you to pay all applicable
fees up to $25.00 , unless you have been granted a fee waiver. We will confirm this agreement in an agreement to pay letter. When
making a request, you may specify a willingness to pay a certain amount if you wish to pay more or less than the standard $25.
I am willing to pay fees for this request up to a maximum of $
I understand that I will be informed if the estimated fees exceeds the amount I am willing to pay.

Part D. FEE WAIVERS
Fee Waivers: If the disclosure of the information is not primarily for commercial interest and if you believe that the disclosure of these
records is in the public interest because it is likely to contribute significantly to public understanding of the operations and activities of
the government, you may ask that applicable fees be reduced or waived. Please explain how your request meets these standards in the
additional comments box below.

Additional
Comments

Part D. Expedited Processing
Expediting Processing: If you can determine that a "compelling need" for the requested information exist, you may ask that your
request be taken out of order an given expedited treatment. Please check that you are requesting expedited processing and then check
the reason you are requesting it.

This circumstances in which the lack of expedited treatment could reasonably be expected to pose an imminent threat to
the life or physical safety of an individual. Please provide details below in support of this claim.

Additional
Comments

or
There is an urgency to inform the public about an actual or alleged Federal government activity, if the information is
requested by a person primarily engaged in disseminating information to the public.
Please provide details below in support of this claim.

Additional
Comments

This request is in accordance with the Paperwork Reduction Act of 1995. The information collection for The Freedom of
Information Act (FOIA), United States Code (USC), §552 allows any person to seek information about an event, an
organization, company or group or another person either living or deceased. The FOIA was enacted in 1966 and has been
amended several times, latest being in 2002. The FOIA provides a statutory right of access to federal agency records within
the Executive branch, which includes the FBI. The basic purpose is to ensure an informed citizenry and provide a check
against corruption by holding the Government accountable. The U.S. Supreme Court has emphasized that FOIA applies to
official information that sheds light on an agency's performance of statutory duties. Subsection (a) of the FOIA discuss “public
access” and requires that agencies to make information publicly available. The collection of information on this form is
necessary to conduct an accurate and timely search FOI/PA request.
Paperwork Reduction Act
The estimate average burden associated with this collection is 15 minutes per respondent or record keeper, depending on
individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this
burden should be directed to FBI Records Management Division PIO Leanna Ramsey 170 Marcel Drive Winchester, VA 22602
or [email protected]
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
displays a currently valid OMB control number.


File Typeapplication/pdf
File Modified2017-10-04
File Created2011-08-15

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