U.S. Bureau of Prisons Electronic 
Freedom of Information Act Request Form

CONTACT INFORMATION

Today's Date:

Requestor Name:

Address1:

(Optional) Address2:

City:

State:

Zip Code:

E-Mail:

(Optional) Telephone:

(Optional) Facsimile:

DESCRIPTION OF RECORDS SOUGHT
I request that a copy of the following documents/information be provided to me:

ASSESSMENT OF FEES
To help us determine your fee status, check ONE of the following requestor categories:

an individual seeking information for personal use
affiliated with a private corporation and seeking information for use in the company's business
affiliated with an educational institution and seeking information for a scholarly purpose
affiliated with a noncommercial scientific institution and seeking information for a scientific purpose
a representative of the news media seeking information as part of a news gathering effort (if media, please identify organization you are affiliated with: )

EXPEDITED PROCESSING
I request expedited processing of my request and have described in detail why I believe my request warrants it:

no compelling need exists to warrant expedited processing of this request
an imminent threat to the life or physical safety of an individual exists
an urgency to inform the public concerning actual or alleged Federal Government activity exists (this option available ONLY for requestors primarily engaged in disseminating information)

Please describe your justification for expedited processing.

PAYMENT OF FEES
I am willing to pay $ or in search, duplication, and processing fees to receive records responsive to this request. If I agree to fees, I understand that I will be notified before fees are incurred ONLY where fees apply and are expected to exceed the amount I've indicated.

Payment must be made via check or money order, payable to the Treasury of the United States.

FEE WAIVER/REDUCTION IN FEES
The Freedom of Information Reform Act of 1986 provides that documents are to be furnished without any charge or at a charge reduced below the fees established if disclosure of the information is in the public interest because it is likely to contribute significantly to public understanding of the operations or activities of the Government and is not primarily in the commercial interest of the requestor.

To evaluate whether the statutory standard authorizing a fee waiver or reduction has been met, we will need additional information upon which to base our determination. If you would like to request a fee waiver, please provide additional information as justification for a fee waiver and/or reduction in fees: