FOIA Request Form

One of the following two options is required

1. Attach a document describing the records you are seeking in a way that will permit the Defense Health Agency (DHA) Privacy and Civil Liberties Office (Privacy Office) to identify and locate them.

Formats accepted: .PDF, .DOC, .DOCX format
Size limit: 1MB

In certain LIMITED circumstances, individual requests are entitled to be moved ahead of other requests on an expedited basis. The following factors must be met and certified to be true and correct:

1. Circumstances in which the lack of expedited treatment could reasonably be expected to pose an imminent threat to the life or physical safety of an individual; or
2. An urgency to inform the public about an actual or alleged Federal government activity, if the information is requested by a person primarily engaged in disseminating information to the public.

Should it be necessary, upon evaluating your request, that complex research and extensive consultation efforts will result, please indicate the fees you would be willing to pay. You are required to select at least one of the choices below:*

The option of a fee waiver is available for qualified parties. To submit a fee waiver request indicate your intent using the radio button below and provide valid explanation in the following field while taking care to address each of the following six (6) factors:

1. A clear statement whether subject of the requested records concerns "the operations or activities of the government."
2. Whether the disclosure is "likely to contribute" to an understanding of government operations or activities.
3. The contribution to an understanding of the subject by the public is likely to result from disclosure: Whether disclosure of the requested information will contribute to "public understanding."
4. The significance of the contribution to public understanding: Whether the disclosure is likely to contribute "significantly" to public understanding of government operations or activities.
5. The existence and magnitude of a commercial interest: Whether the requester has a commercial interest that would be furthered by the requested disclosure.
6. The primary interest in disclosure.

The form being submitted is not using a secure infrastructure. Please ensure that no parts of this field include Personally Identifiable Information (PII) of concern like specifics regarding medical conditions or social security numbers, et al.

By submitting this form I hereby assert that all information provided above is accurate and true to the best of my knowledge.