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AdministrativepdfFederal
Privacy Act Request (5 U.S.C. 552a)
Request under the Privacy Act to access, amend, or obtain an accounting of disclosures of personal records maintained by a federal agency.
PDF TemplateUse the instructions below to complete this form
Instructions
Identify yourself with sufficient detail for the agency to locate your records (full name, date of birth, SSN if applicable). Specify the system of records you believe contains your information. State whether you seek access, amendment, or an accounting of disclosures. Include identity verification as required by the agency. The agency must respond within 10 business days.