Sample Privacy Act Request Letter Date Disclosure Office (FOIA/Privacy Act) Financial Crimes Enforcement Network P.O. Box 39 Vienna, VA 22183 Re: Freedom of Information Act & Privacy Act Request Dear [Disclosure Officer or Coordinator’s Name]: This is a request under the Freedom of Information Act, 5 U.S.C. § 552, and the Privacy Act, 5 U.S.C. § 552a, for copies of all records you have in your possession about me. In an effort to assist with your search for these records, I am providing the following additional information about myself: Full name, Current address, Date and place of birth, Citizenship status. [Optional: Please explain contact, if any, with the Agency and any additional personal data you don’t mind revealing to the agency, such as other names used, former places of residence, foreign travel, government and other employment, political activities, etc., that would help us distinguish between you and other individuals with the same or similar names.] If you deny any or this entire request, please cite each specific exemption you feel justifies the refusal to release the information and notify me of appeal procedures available to me under the law. [Optional: If you have any questions about handling this request, you may telephone me at (home phone) or at my (office phone).] Thank you for your consideration of my request. Sincerely, Name Address City, State, Zip Code Telephone number [Optional] (Individuals submitting a written request for access to their own records must agree to pay duplication costs, identify the System of Records to be searched, and provide a secondary identifier, e.g., certificate of identity, a date of birth or social security number