Your address

Your telephone no.

Date

Director

United States Agency

Washington, D.C.

Dear Madam/Sir:

This is a request under the Freedom of Information Act ( 5
U.S.C. 552 ) and the Privacy Act (5 U.S.C. 552a). I request a
copy of [describe your request; for example, "all documents
maintained by your agency about me"].

In the event that you determine that some portion of a file is
exempt from release, I request that you release any reasona-
bly segregable portion of the documents which is not exempt.
I, of course, reserve my right to appeal such decisions.

In addition, if you determine that some or all of the report is
exempt, I request that you advise me of the applicable exemp-
tion and explain why it applies in this case.

As you know, the law permits you to waive or reduce fees if
this is "in the public interest because furnishing the informa-
tion can be considered as primarily benefitting the public." I
believe that this request fits that category and ask you to waive
any fees.

If you have any questions regarding this request, please feel
free to contact me.

Sincerely,

Your name

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