Personal Information Request Form
This form is being offered to you as an on-line service and is available to you in Rich Text (RTF) and Portable Document (PDF) formats. More detailed instructions will also be offered on the form.
If you choose the RTF format, you will have two options for completing the form:
- Fill in the form on-screen and then print it for submission by mail;
- or print the form and fill in the fields by hand for submission by mail.
If you choose the PDF format, you must print the form and fill in the fields by hand for submission by mail.
If you require a reader to view the form, please go to the Adobe Acrobat Reader download page.
Instructions for completing the form:
- Determine which federal government institution is most likely to have the information you are seeking.
- To apply for information under the Privacy Act, complete the Personal Information Request Form. Describe the information being sought and provide any relevant details necessary to help the institution find it. If you require assistance, refer toSources of Federal Government and Employee Information for a description of personal information banks (PIB) held by the institution or contact its Privacy Coordinator.
- Forward the access request to the Coordinator of the institution holding the information.