Protected when completed

For official use only

Personal Information Request Form

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

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.

Privacy Act


Step 1

Determine which federal government institution is most likely to hold personal information about you using the publication Info Source: Sources of Government and Employee Information ( Decide if you wish to submit an informal request for the information or a formal request under the Privacy Act. If you wish to make an informal request, contact the institution’s Access to Information and Privacy Coordinator (http://www.tbs-sct.gc.ca

Step 2

To obtain your personal information under the Privacy Act, complete this form. Describe the information being sought and provide relevant details necessary to help the institution find it. If you require assistance, refer to Info Source ( a description of records held by the institution or contact the institution’s Access to Information and Privacy Coordinator.

Step 3

Forward this form to the Access to Information and Privacy Coordinator of the institution holding the information.

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 Privacy Commissioner of Canada if you believe that you have been denied any of your rights under the Act.

TBC/CTC 350-0058E (Rev. 06/2014)

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