FOIA Request Form

Requester Contact Information:

Your Name:

Street Address:

City:

State or Country: Zip or Postal Code:

Organization (If Applicable)

Address Type: Home

Business

Daytime Phone Number: Alternative Phone Number

Request on behalf of another

party:

No

Yes

If so, which party:

FAX Number:

Your E-mail address

Preferred Communication: Phone

E-mail

(Providing an e-mail address allows OSHRC to communicate with you electronically when 

appropriate. It will also ensure that you receive an e-mail confirmation of our receipt of your request.) 
Your Request:

Please describe the record(s) you are seeking so that an employee familiar with the subject area of the request may locate 

existing record(s) with a reasonable amount of effort. If you are requesting case file records, please provide as much information

as possible, such as case name, docket number, inspection number, and/or the specific document(s) or pleading(s) you are

seeking. Remember that investigative documents are typically available only from the Occupational Safety and Health 

Administration (OSHA), which is separate from OSHRC.

Request Description:

Desired Format:

* Note that paper options may result in additional fees for copying.

Expedited Processing:

A request for expedited processing must set forth the reasons why the request should be expedited. You must certify that the

reasons given for seeking expedited processing of this request are true and correct to the best of your knowledge and belief. The 

FOIA Office will notify you of its decision whether to grant expedited processing within ten days after receiving the certified

request. If OSHRC denies the request for expedited processing, you will be advised of your right to submit an administrative 

appeal, which will be handled expeditiously. A reporting or court deadline is not a sufficient justification.

Select the applicable reason why you are 

requesting expedited processing:

There is an imminent threat to the life or physical safety of an 

individual.

There is an urgency to inform the public concerning actual or

alleged Federal government activity and the request is made by a 

person primarily engaged in disseminating information.

You MUST provide a justification statement that explains in detail how your request meets one or both of the criteria above, and 

certify that your explanation is true and correct to the best of your knowledge and belief if you have requested expedited 

processing. See 29 C.F.R. § 2201.6(e)(1).

Justification:
Certification: I certify that the above statement(s) concerning expedited

processing are true and correct to the best of my knowledge and

belief

Fees and Waivers:

Please be advised that by making a FOIA request, it shall be considered an agreement by you to pay all fees unless you have 

been granted a fee waiver or specify your willingness to pay fees up to a particular amount. 

Please select the appropriate statement:

Fee amount authorized for request:

If we find that the actual cost of processing your request will exceed the amount you specified above, we will

stop processing the request and consult with you.

For fee purposes, select one of the 

following categories: 

(Note: Commercial use is defined as a use 

or purpose that furthers commercial, trade, 

or profit interests, including through 

litigation. See 29 C.F.R. § 2201.4(e)).

 I am an individual or organization requesting these materials for a commercial

 use 

I am a representative of an educational or scientific institution, whose purpose

 is scholarly or scientific research, and my request is not for a commercial use

 I am a representative of the news media, and my request is not for a commercial

 use (records supporting news-dissemination are not considered "for commercial

use")

 I am an individual or organization not considered educational, scientific, or a

member of the news media, requesting materials for a non-commercial use

News Media/ Educational or

Noncommercial Scientific Institution

Affiliation:

If you are requesting a fee waiver,

check both boxes to the right to

confirm that you meet OSHRC's fee

waiver criteria.

Disclosure of the information is in the public interest

because it is likely to contribute significantly to public 

understanding of the operations or activities of the

Government.

Disclosure of the information is not primarily in my

commercial interest.

Explain how you and your request

fall within the above two fee waiver

criteria.

Complete, Save, and Email form as an attachment to 

OSHRC_FOIA@Oshrc.gov or Fax to (202) 606-5417