2 Ill. Adm. Code 901.APPENDIX A
A Freedom of Information Request Form
Section 901.APPENDIX AĀ Ā Freedom of Information Request
Form
Name
of Agency
City
INSTRUCTIONS:
Requestor
should fill out the request portion (the top half) and sign the Requestor's
Signature block. Send copies 1 and 2 to the Agency.Ā Keep the 3rd copy for
references. Send no money at this time. Unless notified otherwise the
Agency's response for APPROVED, DENIED or DEFERRED will be sent back within 7
working days after receipt of the form.
Address
Requestor's
Name (or business name if applicable)
Date
of Request
Phone
Number
Street
Address
CERTIFICATION
REQUESTED
YES
NO
Requestor's
Signature
City
State
Zip
DESCRIPTION
OF RECORDS REQUESTED:
REQUESTING
COPIES
TO INSPECT RECORDS
AGENCY
RESPONSE (REQUESTOR DOES NOT FILL IN BELOW THIS LINE)
APPROVED
The
documents requested are enclosed.
The
documents will be made available upon payment of copying costs ............................................... $_____________
You
may inspect the record at ___________________________________________________________________________
on
the date of ______________________.
DENIED
The
request creates an undue burden on the public body in accordance with Section
3(f) of the Freedom of Information Act, and we are unable to negotiate a more
reasonable request.
The
materials requested are exempt under Section 7____ of the Freedom of
Information Act for the following reasons:
INDIVIDUAL(S)
THAT DETERMINED REQUEST TO BE DENIED
RIGHT TO APPEAL
If
desired, submit the attached APPEAL form (No. 2) along with copies of the
original REQUEST and reasons for appeal to:
DEFERRED
Request delayed,
for the following reasons (in accordance with 3(d) of the DOIA):
You
will be notified by the date of ___________________________ as to action
taken on your request.
The
information required by this form is MANDATORY in order to comply with P.A.
83-1013.Ā Failure to so provide may result in this form not being processed.
This form is approved by the Form
Management
Center.
FOIA
Officer
Date
of Reply
IL-001
ā 0005Ā (6/84)
LEGEND
FOR REQUESTOR: 1st copy (white) ā send to Agency; 2nd copy (yellow) ā send to
Agency; 3rd copy (pink) ā Requestor's copy