FDA FOIA Request Form

By submitting a request through this portal, you attest and certify that all the information provided herein is true and accurate to the best of your knowledge. Unauthorized or improper use of this system may result in disciplinary action, as well as civil and criminal penalties.

^*Description of Requestor

	Commercial user
	Educational institution or noncommercial scientific institution operated primarily for scholarly or scientific research
	Representative of the news media
	Consumer
	None of the above (explain)

^*Fee Information

FDA may charge a fee for the processing of your FOIA request. For detailed information on our fee schedule, please see FDA’s FOIA page.
Please indicate the maximum dollar amount you are willing to pay for the processing of your request. The agency will contact you if estimated fees are greater than the amount entered.
Max Amount:	$

^*Minor Deletions

Individual Information

Title:
^*First Name:
Middle Initial:
^*Last Name:

Mailing Address

^*Address 1:

Address 2:

^*City:

^*Country:

^*State:

^*Zip Code:

^*Primary Phone:

e.g. 111-111-1111

Other Phone:

e.g. 111-111-1111

^*Email:

^*Confirm Email:

* Please include the country code for international phone numbers.
** Response will be sent to Mailing address.

Billing Address

Same as Mailing

^*Address 1:

Address 2:

^*City:

^*Country:

^*State:

^*Zip Code:

Additional Requester Information

Requester Internal Reference #:
^*Requester Name:

Request Details

Date Range of Requested Records:	From mm/dd/yyyy To mm/dd/yyyy
^*Subject (i.e. description of records): Max 2000 characters
* In the “Subject” field, please describe or list the types of records you are seeking. If you describe a product or health issue, but do not describe the records you are seeking, we will not be able to process your request. ** If you are seeking inspection records, please provide the name and location of the inspected facility, and the type of inspection records you are seeking.

Attachment (optional)

Request Letter:
* Only Microsoft Word, PDF, Word Perfect, and text files are accepted.

Waiver of Fees

Pursuant to the FOIA and 21 C.F.R. 20.46, the FDA may grant a waiver or reduction of fees when certain criteria are met (see CFR - Code of Federal Regulations Title 21 Section 20.46 Waiver or reduction of fees for details). If you believe that you meet these criteria and would like to request a fee waiver or reduction, please provide your justification below. If you are a media or scientific/educational nonprofit requester, you are not subject to search or review fees, and get 100 pages of free duplication. Therefore, a fee waiver is likely unnecessary.
Request waiver of fees:
^* Justification: Max 4000 characters

Expedited Processing

Pursuant to the FOIA and 21 C.F.R. 20.44, the FDA may provide expedited processing of an FOIA request in specific circumstances (see CFR - Code of Federal Regulations Title 21 Section 20.44 Expedited processing for details). If you believe that you meet these criteria and would like to request expedited processing, please provide your reason and justification below.
Request expedited processing:
^*Reason:
^* Justification: Max 4000 characters

Requester:

General

Description of Requester:
Max Amount Willing to Pay:	$
Minor Deletions:	Yes

Organization

First Name:

Middle Initial:

Last Name:

Primary Phone:

Other Phone:

Email:

Address 1:

Address 2:

City:

Province:
Postal Code:

Country:

Address 1:

Address 2:

City:

Province:
Postal Code:

Country:

Details

Requester Name:
Requester File #:		Request Letter:
Requested Date From:		Requested Date To:
Subject of Request:

Waiver of Fees

Justification:

Expedited Processing

Reason:
Justification:

By submitting a request through this portal, you attest and certify that all the information provided herein is true and accurate to the best of your knowledge. Unauthorized or improper use of this system may result in disciplinary action, as well as civil and criminal penalties.

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FDA FOIA Request Form

By submitting a request through this portal, you attest and certify that all the information provided herein is true and accurate to the best of your knowledge. Unauthorized or improper use of this system may result in disciplinary action, as well as civil and criminal penalties.

By submitting a request through this portal, you attest and certify that all the information provided herein is true and accurate to the best of your knowledge. Unauthorized or improper use of this system may result in disciplinary action, as well as civil and criminal penalties.

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