* indicates required field

• Your Name*:
• Company/Organization:
• Mailing Address*:
• City*:
• State:* Please Select Arizona California Hawaii Nevada
• Zip*:
• *Email: *Providing an e-mail address allows EPA to communicate with you electronically when appropriate.
  You will also receive an e-mail confirmation of this request.
• Phone ###-###-####:
• Fax ###-###-####:

• Description of Records

  Provide a description of the records you are seeking in a way that will permit EPA to identify and locate them. If you are seeking records relating to a facility, site or regulated entity, please include the complete name and address of each property you are inquiring about.

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  Fees

  Select the amount you agree to reimburse the Agency for fees incurred to process your request. Refer to the FOIA Reference Guide for complete details.

  Up to $25.00
  Other Specified Amount Required for other specified amount.

  We will contact you if the estimated costs will exceed your authorized amount.

  Please fill out the form if checked. Yes, I am requesting a fee waiver.

  In certain limited circumstances, individual requests are entitled to a fee waiver. The following factors must be met:

  If you wish to request a fee waiver include the following sections in your request: (100 character minimum)

  A clear statement whether subject of the requested records concerns “the operations or activities of the government.”

  Whether the disclosure is “likely to contribute” to an understanding of government operations or activities.

  The contribution to an understanding of the subject by the public is likely to result from disclosure: Whether disclosure of the requested information will contribute to “public understanding.

  The significance of the contribution to public understanding: Whether the disclosure is likely to contribute “significantly” to public understanding of government operations or activities.

  The existence and magnitude of a commercial interest: Whether the requester has a commercial interest that would be furthered by the requested disclosure.

  The primary interest in disclosure.

  Please provide your justification for requesting a waiver. (100 character minimum)
  

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  Expedited Processing

  Yes, I am requesting expedited processing. (50 character minimum)

  In certain LIMITED circumstances, individual requests are entitled to be moved ahead of other requests on an expedited basis. The following factors must be met and certified to be true and correct:

  Circumstances in which the lack of expedited treatment could reasonably be expected to pose an imminent threat to the life or physical safety of an individual; or

  An urgency to inform the public about an actual or alleged Federal government activity, if the information is requested by a person primarily engaged in disseminating information to the public.

  Please provide your justification for requesting expedited processing.
  (50 character minimum)
  

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