U.S. Department of Justice Federal Bureau of Investigation FOIA Request Form Requester's Name: Address: Phone Number (optional): Fax Number (optional): E-Mail (optional): Subject: In order to help to determine status to assess fees, select: O An individual seeking information for personal use O Affiliated with an educational or noncommercial institution, and this request is made for a scholarly purpose O Affiliated with a private corporation and seeking information for use in the company's business O A representative of the news media and this request is made part of news gathering and not for commercial use Enter media name: Select type of Media: n Newspaper C Magazine Television Station C Other EFTA01155108 Purpose: Enter maximum amount you are willing to pay: $ Explanation for a request for a waiver of fees: Additional Comments: [ PRINT This form cannot be used for Privacy Act requests or requests for information about a third party. SEND 1 EFTA01155109