P-2010-00947 INITIAL REQUEST

• Document Type: FOIA
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 05564006
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 6
• Document Creation Date: March 9, 2023
• Document Release Date: December 8, 2021
• Case Number: F-2011-02160
• Publication Date: July 30, 2010

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Information and Privacy Coordinator
Central Intelligence Agency
Washington, D.C. 20505
Fat [phone]
Via FAX and Certified Mail Return Receipt Requested
July 27, 2010
Dear RNA Coordinator,
This letter is a formal request under Freedom of Information Act (FOIA), as amended (5 LISC �
522(a)), for all nonexempt portions of the information described below:
All documents, forms or other written, photographic, electmnic, computer, or recorded materials,
memorandums, letters, e-mails, supporting dOCUMentatiOnS, any and all correspondence with
other agencies regarding me as well as any and all responses from those agencies including
including, but not
limited to directives, memorandums, reports, e-mails, letters, telephonic transcripts or
notes, video materials, etc
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Date range of request; from 01/411/1993- 01/01/2005
I am seeking information for personal use and not for commercial purposes.
As you are aware, the FOTA permits fees to be charged only lor search and copying costs and not
for review of materials.
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Section 522(a)(3) of the FOIA requires agencies to make documents and information promptly
available. Section 522(a)(4) permits "recovery of only direct costs of such search and
duplication". Therefore, agencies arc required by law to make documents available for inspection
and may not require the purchase of copies of documents.
I agree to pay search and copying cost associated with this request. Should your office estimate
that any fees should be charged above $500.00 I request prior notification.
I respectfully ask that you respond within 20 business days from the date of the receiving of the
request according to FOIA regulations.
I declare, certify, verify or state under penalty of perjury under the laws of the United States of
America, that the foregoing is true and correct.
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U.S, Department of Justice Certification of Identity
Privacy Act Statement. In accordance with 28 CFR Section 16.41(d) personal data sufficient to identity the individuals sub
by mail under the Privacy Act of 1974,5 U.S.C. Section 552a, is required. The purpose of this solicitation is to ensure that the reco
individuals who are the subject of U.S. Depamnent of Justice systems of records are not wrongfully disclosed by the Department. Failur
furnish this information will result in no action being 'Liken on the request. False information on this form may subject the requester to criiii-.
inal penalties under 18 U.S.C, Section 1001 and/or 5 U.S.C. Section 55250)(3).
Public reporting burden for this collection of information is estimated to average 0.50 hours per response, including the time for review-
ing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection
of information. Suggestions for reducing this burden may be submitted to Director, Facilities and Administrative Services Staff, Justice
Management Division, U.S. Department of Justice, Washington, DC 20530 and the Office of Information and Regulatory Pants, Office
of Management and Budget, Public Use Reports Project 11.13-0016) Washincnon nr
Full Name of Requester
Citizenship Statu
Current Addre
Date of Birth
Social Security Number 3
Place of Birth
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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, 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 or by imprisonment of not more than five years or both, and that requesting or obtaining any record(s)
under false prcten I -I I. " " 552a(i)(3) by a fine of not more than $5,000.
Signature 4
Date 07
22.
OPTIONAL: Authorization to Release Information to Another Person
This form is also to be complete(' by a requester who is authorizing information [elating to himself or herself to be released w another person.
Further, pursuant to 5 U.S.C. Section 552a(b), 1 authorize the U.S. Department of Justice to release any and all information relating to me to;
Print or Type Name
I Name of individual who is the subject of the record sought,
2 Individual submitting a request under the Privacy Act of 1974 must be either "a citizen of the United States or an Alien lawfully
admitted for permanent residence," pursuant to 5 U.S.C. Section 552a(a)(2). Requests will be processed as Freedom of Information Act
requests pursuant to 5 U.S.C. Section 552, rather than Privacy Act requests, for individuals who arc not United States citizens or aliens
lawfully admitted for permanent residence.
3 Providing your social security number is voluntary. You are asked to provide your social security number only to facilitate the
identification of records relating to you. Without your social security number, the Department may be unable to locate any or all records
pertaining to you.
4 Signature of individual who is the subject of the record sought.
FORM APPROVED OMB 16(3. 1103-0016
EXPIRES 1W31/16
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FORM D01-361
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; Date: **talc
Tuesday, July 27, 2010
Number dialed:**************** 703-613-3007
Attn.****ammanamaaana*
; INFORMATION AND PRIVACY ;
COORDINATOR
**************aaa******aa F014
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Total number of pages to be sent:* 15
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