ELECTRONIC FOIA REQUEST FOR INFORMATION

	FOIA request for information Electronic Submission Form

This form is not currently working properly. Please FAX your request to 202-219-3092. Thank you.

Use this FOIA request form ONLY when requesting Office of Surface Mining information.
For ALL other government agency requests go to www.firstgov.gov.

I am requesting, under the Freedom of Information Act (FOIA), the following records: (Describe records you want, where they might be located, time frame, author, recipient, type, i.e., reports, letters, memoranda, forms, e-mail, etc.)

Regarding fees (Check one)
I am willing to pay applicable fees for processing my FOIA request. If you check this button YOU MUST check one of the fee categories below. (See FEE SCHEDULE in the Reference Guide
Fees are based on the category of use. For fee purposes, this FOIA request is for: (check one). (If you have questions see FEE CATEGORIES in the Reference Guide
Commercial use
Educational use
Non-commercial scientific institution
News media
Other (private use)
I am requesting a fee waiver, below is my justification for the waiver.
Justification for the fee waiver:

Name and address

(Name)
(Organization)
(Street)
(City) (State)
(Country, if NOT United States)
(Zip code)
(E-mail address)
(Telephone Number, with area code)
(Fax Phone Number)

(OSM FOIA page) (OSM Home Page)

Willie Chism, Pagemaster
Office of Surface Mining
1951 Constitution Ave. N.W.
Washington, D.C. 20240
202-208-2961
getinfo@osmre.gov