Privacy Act Requests

Requesting Your Records Under the Privacy Act

The Privacy Act of 1974, 5 U.S.C. 552a, as amended, allows individuals to gain access to their own personal records subject to certain exemptions, and to seek correction or amendment of records maintained by Federal agencies that are inaccurate, incomplete, untimely, or irrelevant.  It also safeguards confidentiality by limiting or restricting disclosure of personally identifiable records maintained by Federal agencies, and balances the Government's need to maintain information about individuals with the rights of individuals to be protected against unwarranted invasions of their privacy resulting from the collection, maintenance, use, and disclosure of personal information.

The Privacy Act pertains only to information that is maintained in a "system of records", which is defined as a group of agency-controlled records from which information is retrieved by a unique identifier, such as an individual's name or employee identification number.  The Privacy Act further defines a "record" as any individually identifiable set of information that an agency might maintain about a person.  For example, a record that may be sought by an individual includes employment records.  

These rights are outlined in the Department of the Interior (DOI) Privacy Act regulations at 43 CFR Part 2, Subpart K, which provide procedural guidance to individuals on how they can request notification of existence of records on themselves, and how they can access those records maintained by DOI.

How to File a Privacy Act Request

The Privacy Act allows individuals to seek records about themselves that are maintained in a DOI system of records.  For a list of Government-wide and DOI systems of records visit the DOI System of Records Notices (SORNs) webpage.  Such a request may be processed under both the Privacy Act and the Freedom of Information Act (FOIA) to ensure the greatest possible disclosure of records allowed under the law.

Privacy Act requests for notification, access to, or correction or amendment of Privacy Act records must be submitted in writing to the System Manager identified in the applicable SORN, must be signed, and must meet requirements identified in the published SORN and DOI Privacy Act regulations at 43 CFR Part 2, Subpart K.  System Managers may require additional information, proof of identity, or a notarized statement or statement signed under penalty of perjury stating you are the person who is the subject of the record requested.  

Individuals may use the following forms to make a Privacy Act request. Please read the forms carefully and provide the requested information.  

• DI 4016 Request For Individual Access To Records Protected Under The Privacy Act [pdf] (357.09 KB)

  .  This form is to request access to your records. This form may also be used if you are the parent of a minor or a legal guardian seeking access to records.  

• DI 4017 Consent For Disclosure Of Records Protected Under The Privacy Act [pdf] (359.47 KB)

  .  This form is to provide consent to disclosure of your records to another person or entity. This form may also be used if you are the parent of a minor or legal guardian consenting to and authorizing disclosure of records. 

The following information may be required from you to process your Privacy Act request.

1. Full name, aliases, or other names used.
2. Current address.
3. Telephone number and contact information so we may contact you if necessary.
4. Any additional identifying information that would help us verify your identity.
5. Bureau, office, or program that maintains the requested record(s).
6. The specific system of records, or a clear description of the record(s) including date range, subject matter, contacts or persons involved, place records were created, applicable system of records, and other pertinent details.  The description should be specific enough to help us locate the records you are seeking.
7. A notarized statement or statement of perjury.  
8. Date.
9. Your signature.

All requests must be signed and submitted under the penalty of perjury statement below or you may provide a notarized statement.

I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct, and that I am the person named above and requesting access to my records, or records that I am entitled to request as the parent of a minor or the legal guardian of an incompetent, and I understand that any falsification of this statement is punishable under the provisions of 18 U.S.C. § 1001 by a fine, imprisonment of not more than five years, or both, and that requesting or obtaining any record(s) under false pretenses is punishable under the provisions of 5 U.S.C. § 552a(i)(3) by a fine of not more than $5,000. 

Please note that we will notify you if we need further information or if your request lacks sufficient information to enable us to process it.  You should keep a copy of your request as a reference for further correspondence with DOI.  

The request and envelope should be labeled “PRIVACY ACT REQUEST” and be submitted to the System Manager identified in the pertinent SORN, or may be submitted to the Privacy Office at the DOI bureau or office that maintains the record being requested. DOI bureau and office mailing and email contact information are available on the DOI Privacy Contacts webpage.  Privacy Act requests may also be submitted to the DOI Privacy Office, 1849 C St NW, Room 7112, Washington, DC 20240, Attention: Privacy Act Request.

A request for records made under FOIA should be submitted by completing the DOI FOIA Request Form on the DOI FOIA Program website.

Requesting Amendment or Correction of Records under the Privacy Act

The Privacy Act allows you seek amendment for information contained about you that is erroneous, however, this only pertains to factual matters and not matters of opinion.

Requests for amendment or correction of records must be submitted in writing to the System Manager identified in the applicable SORN, must be signed, and must meet requirements identified in the published SORN and DOI Privacy Act regulations at 43 CFR Part 2, Subpart K.  System Managers may require additional information, proof of identity, or a notarized statement or statement signed under penalty of perjury stating you are the person who is the subject of the record requested.

The following information may be required from you to process your Privacy Act request.

1. Full name, aliases, or other names used.
2. Current address.
3. Telephone number and contact information so we may contact you if necessary.
4. Any additional identifying information that would help us verify your identity.
5. Bureau, office, or program that maintains the requested record(s).
6. The specific system of records, and a clear description of the record(s) to be amended including date range, subject matter, contacts or persons involved, place records were created, applicable system of records, and other pertinent details.  The description should be specific enough to help us locate the records.
7. A description of why the individual believes the record is not accurate, relevant, timely or complete; with copies of documents or evidence in support of the request.
8. The request must specify in detail the requested changes to the record; and must include proposed language if the change involves rewriting the record or adding new language to the record.
9. A notarized statement or statement of perjury.
10. Date.
11. Your signature.

All requests must be signed and submitted under the penalty of perjury statement below or you may provide a notarized statement.

I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct, and that I am the person named above and requesting access to my records, or records that I am entitled to request as the parent of a minor or the legal guardian of an incompetent, and I understand that any falsification of this statement is punishable under the provisions of 18 U.S.C. § 1001 by a fine, imprisonment of not more than five years, or both, and that requesting or obtaining any record(s) under false pretenses is punishable under the provisions of 5 U.S.C. § 552a(i)(3) by a fine of not more than $5,000. 

Please note that we will notify you if we need further information or if your request lacks sufficient information to enable us to process it.  You should keep a copy of your request as a reference for further correspondence with DOI.  Requests for amendment may be submitted only after the individual has previously requested and been granted access to the record and has inspected or been provided a copy of the record.  Please note it is important to include a specific description of the information to be amended and to provide copies of available evidence supporting the request as the burden of proof rests with the requesting individual.

The request and envelope should be labeled “PRIVACY ACT REQUEST” and be submitted to the System Manager identified in the pertinent SORN, or may be submitted to the DOI bureau or office Privacy Officer for the bureau or office that maintains the record.  Visit the DOI Privacy Contacts webpage for a list of DOI Privacy Officers.  If you do not know where to submit your request, you may send it to the Departmental Privacy Officer, U.S. Department of the Interior, 1849 C Street NW, Room 7112, Washington, DC 20240.

For information on processing and decisions on Privacy Act requests, please see DOI Privacy Act regulations at 43 CFR Part 2, Subpart K.

Freedom of Information Act (FOIA) Requests

You can learn more about the DOI FOIA Program by visiting https://www.doi.gov/foia. 

For questions about the Privacy Program, please contact:
DOI Privacy Office
U.S. Department of the Interior
1849 C Street NW, Room 7112 
Washington, DC 20240 
DOI_Privacy@ios.doi.gov