Making a Privacy Act (PA) Request

Information Required

 

Please note that you must be a United States Citizen, or an alien lawfully admitted for permanent residence to the U.S. to make a request for Privacy Act records. In order to provide you with the requested information, the following identity verification data is needed (in addition you must also include one of the perjury statements listed below).

- Provide your full name, address, telephone and/or email (or other names used)

- Relationship 

- Who the request is regarding (name of individual, if not yourself, or investigation) 

- Social Security Number (providing the SSN of the individual whom the request is pertaining to is voluntary). The SSN will be used to facilitate the identification of records. Please note that without the SSN, we may not be able to locate the records requested.

- Country of Citizenship or if you are an alien lawfully admitted for permanent residence in the U.S.:

- Statement (If applicable): Under the Freedom of Information Act-Privacy Act, I am requesting information regarding the above named individual or file. (If the information is in regard to a minor, are you're the legal guardian, custodian?) (Please provide additional information depending on the situation to support your request).

- Wet signature (REQUIRED) and Date

 

This statement is required if someone is asking for Privacy Act Information about themselves: 

Requester Name:_____________________ 

I, declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct, and that I am the person named above (requester) and I understand that any falsification of this statement is punishable under the provisions of 18 U.S.C. section 1001 by a fine of not more than $10,000.00 or by imprisonment of not more than five years or both, and that requesting or obtaining any record(s) under false pretenses is punishable under the provisions of 5 U.S.C. 552a(i)(3) by a fine of not more than $5,000.00. 

 

This statement is required if someone is authorizing another person (Third Party) to receive Privacy Act Information about them: 

I, ______________________ (name of person whose information is being sought) authorize release of my information which is protected under the Privacy Act to ________________________________ (name of Third Party receiving information)

I, declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct, and that I am the person named above (requester) and I understand that any falsification of this statement is punishable under the provisions of 18 U.S.C. section 1001 by a fine of not more than $10,000.00 or by imprisonment of not more than five years or both, and that requesting or obtaining any record(s) under false pretenses is punishable under the provisions of 5 U.S.C. 552a(i)(3) by a fine of not more than $5,000.00.

 

A letter template may be downloaded here.

A list of information exempted by the PA may be downloaded here.

 

All Privacy Act requests must be submitted by mail, any Privacy Act request submitted via email or fax will not be processed.

U.S. Postal Mailing Address:

USCYBERCOM/J0 FOIA-PA Requester Service Center
9800 Savage Rd., Suite 6171
Fort George G. Meade, MD 20755

Fax: (443) 654-4778
E-Mail: cybercom_foia@cybercom.mil