Information and Privacy Coordinator
Central Intelligence Agency
Washington, D.C. 20505
Under the Freedom of Information Act, 5 U.S.C. subsection 552 and the Privacy Act, 5 U.S.C. section 552a, please furnish me with copies of all records about me indexed to my name.
To help identify information about me in your record systems, I am providing the following required information:
Full name, current address, date and place of birth, citizenship status
Optional: Please explain contact, if any, with the Agency or any other information that would help us distinguish between you and other individuals with the same or similar names.
If you deny all or any part of this request, please cite each specific exemption that forms the basis of your refusal to release the information and notify me of appeal procedures available 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).
Statement swearing under threat of perjury that above information is true or have the letter notarized.