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Checklist for Requests for Personal Information

In order to process a request for personal information, the Department of State requires the following:

Full name (and any aliases) of the individual(s) who is/are the subject of the request
Current Mailing Address
Date of birth
Place of birth (city and state/country)
An adequate description of the records you are seeking
Timeframe
Origin of the records
Citizenship Status
Notarized signature or Under Penalty of Perjury Statement *

If you wish to authorize another individual to access your records, please include the Department’s Consent for Disclosure of Records Protected under the Privacy Act form (download the form by clicking here for a fillable PDF version) or you may submit the authorization on your letterhead or plain paper.

Third Party Authorization (if applicable) **

* The Department of State cannot accept requests for personal records without either a notarized signature or signature accompanied by an under penalty of perjury statement. If using a notary, your request should bear your signature and the signature and seal of the notary, and be dated within six months of the date of the request. In lieu of notarization, you may make the following statement: “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.” This statement should be signed, and be dated within six months of the date of the request.

** In general, under the provisions of the FOIA and Privacy Act, access to information about private individuals cannot be given to unauthorized third parties absent the individuals’ written consent. The Department of State can and will process requests without consent, but release of records will be severely limited to protect the privacy of the subject individuals.