Request for Individual Access to Records Protected under the Privacy Act
 

Instructions: If you are seeking access to your records, please provide the information below. For more information on FERC’s privacy program, please see here.

Information Required for Identity-Proofing and Authentication
Title

This information is required for FERC to verify your identity.

Describe what information is requested. Please provide enough detail so that knowledgeable staff may locate the record(s) with a reasonable amount of effort. The description should include the time frame to be searched, as well as titles of document and offices to be searched. The more detail you provide, the better opportunity there is to determine if the records exist and where.

Address and Information for Receiving Records

Certification for Access to Records

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, 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.

Placing your name inside this field represents your legal signature and consent.

Privacy Act Statement

In accordance with FERC’s Privacy Act policies, personal information sufficient to identify the individuals requesting access to records under the Privacy Act of 1974, 5 U.S.C. § 552a, is required. The purpose of this solicitation is to ensure that the records of individuals who are the subject of FERC’s systems of records are not wrongfully disclosed by FERC. Requests will not be processed if this information is not furnished. False information on this form may subject the requester to criminal penalties under 18 U.S.C. § 1001 and/or 5 U.S.C. § 552a(i)(3). Please see FERC’s SORNs at https://www.ferc.gov/privacy/ferc-system-records-notice-sorn, specifically, relating to Privacy Act requests here, https://www.govinfo.gov/content/pkg/FR-2016-09-07/pdf/2016-21418.pdf, and here https://www.govinfo.gov/content/pkg/FR-2014-03-28/pdf/2014-06993.pdf