HTML version of the form: Access to Information Request Form

Protected when completed

For official use only

Access to Information Request Form

• Federal Government Institution:
• Provide details regarding the information being sought (e.g. subject matter, date range, type of records):
• Method of access preferred (Please choose one)
  • Receive paper copies of the documents
  • Receive electronic copies of the documents
  • Examine the documents in government offices
• Name of applicant:
• Street, address, apartment:
• City or town:
• Province:
• Postal Code:
• Telephone number:
• This request for access to information under the Access to Information Act is being made by
  • a Canadian citizen, a permanent resident or an individual present in Canada, best described as:
    • media
    • academia
    • business
    • organization
    • member of the public
    • decline to identify
    OR
  • a corporation present in Canada

This information is collected for statistical purposes and is published annually on the Government of Canada Info Source website (www.infosource.gc.ca).

Please note that the institution may contact you to verify your identity and to confirm that you have a right of access under the Access to Information Act.

• Date:

The personal information provided on this form is protected under the provisions of the Access to Information Act and the Privacy Act and is retained and used as described in Personal Information Bank PSU 901 of the institution to which this form is submitted.

Access to Information Act

Instructions:

Step 1

Determine which federal government institution is most likely to have the information you are seeking using the publication Info Source: Sources of Government and Employee Information (http://infosource.gc.ca/emp/emp05-eng.asp#chapters). Decide if you wish to submit an informal request for the information or a formal request under the Access to Information Act. If you wish to make an informal request, contact the institution’s Access to Information and Privacy Coordinator (http://www.tbs-sct.gc.cahttp://www.tbs-sct.gc.ca/ap/atip-aiprp/coord-eng.asp).

Step 2

To request information under the Access to Information Act, complete this form or submit a written request mentioning the Act. Describe the information being sought and provide relevant details necessary to help the institution find it. If you require assistance, refer to Info Source (http://infosource.gc.ca)for a description of records held by the institution or contact the institution’s Access to Information and Privacy Coordinator.

Step 3

Forward this form or your written request to the Access to Information and Privacy Coordinator of the institution holding the information. Requests are subject to a $5 application fee. Do not send cash payment. If you are making a request to an institution with a Receiver General Account (http://www.tpsgc-pwgsc.gc.ca/recgen/pceaf-gwcoa/1314/txt/rg-3-alpha-eng.html), your cheque or money order is payable to the Receiver General for Canada. For requests to all other institutions, cheques or money orders must be made out to the institution itself. Please be aware that you may be required to pay other fees depending on the circumstances of your request.

Step 4

Should you have any questions about the response to your request, please contact the Access to Information and Privacy Office of the institution. You have the right to complain to the Information Commissioner of Canada if you believe that you have been denied any of your rights under the Act.

TBC/CTC 350-0057E (Rev. 07/2014)