Agency Head or Appeal Officer
Name of Agency
Address of Agency
City, State, Zip Code

Re: Freedom of Information Act Appeal

Dear _____________:
 

        This is an appeal under the Freedom of Information Act.

        On [date], I requested documents under the Freedom of Information Act.  My request
        was assigned the following identification number:________.  On [date], I received a
        response to my request in a letter signed by[name of official].  I appeal the denial of
        my request.

        [Optional] The documents that were withheld must be disclosed under the FOIA 
        because....

        [Optional] I appeal the decision to deny my request for a waiver of fees.  I believe that I
        am entitled to a waiver of fees.  Disclosure of the documents I requested is in the public
        interest because the information is likely to contribute significantly to public 
        understanding of the operations or activities of government and is not primarily in my
        commercial interest. [Provide details]

        [Optional] I appeal the decision to require me to pay review costs for this request.  I am
        not seeking the documents for commercial use. [Provide details]

        [Optional] I appeal the decision to require me to pay search charges for this request. 
        I am a reporter seeking information as part of a news gathering and not for commercial use.

        Thank you for your consideration of this appeal.

Sincerely,


Name 
Address 
City, State, Zip Code 
Telephone Number [Optional]