FOIA REQUEST FORM

	Sample FOIA Request Form

Following is a sample letter for submitting a Freedom of Information Act (FOIA) request for information. This form letter can be copied and the information filled in on the blank lines and sent via fax or U.S. Postal Service mail. If you fax your request use the number on the sample form, if you mail your request send it to:
Office of Surface Mining
Freedom of Information Act Officer
South Interior Building, Mail Stop 144
1951 Constitution Ave., N.W.
Washington, DC 20240

Send FOIA requests to this address or fax number ONLY when requesting Office of Surface Mining information. For ALL other government agency requests go to www.firstgov.gov.

     
                                     FOIA REQUEST

                                             Date:____________

To:  FOIA Officer, Office of Surface Mining
Telefax:  202-219-3092            
Telephone:  202-208-2961

I am requesting, under the Freedom of Information Act (FOIA), the following records
from the Office of Surface Mining Reclamation and Enforcement, U.S. Department of
the Interior.  (Describe the records you want, where they might be located, time frame,
author, recipient, type., i.e., reports, letters, memoranda, forms, E-mail, etc.)

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Regarding fees: (Check one.)

____ I am willing to pay applicable fees for processing my FOIA request.  (Check
     applicable fee category; see Reference Guide for help.)
          ___  Commercial use
          ___  Educational use
          ___  Non-commercial scientific institution
          ___  News media
          ___  Other (private use)

____ I am requesting a fee waiver.  Justification for fee waiver is attached.  (Attach
     separate sheet; see Reference Guide for help.)

                         Submitted by:

                         __________________________________________
                         Name

                         __________________________________________
	                __________________________________________
                         __________________________________________
                        Address

                         _____________________/_____________________
                         Telephone/Telefax

(Home Page)

Office of Surface Mining
1951 Constitution Ave. N.W.
Washington, D.C. 20240
202-208-2719
getinfo@osmre.gov