The following is a model form created by the FLRA Office of the General Counsel to assist

agencies in responding to information requests by unions under section 7114(b)(4) of the Federal Service

Labor Management Relations Statute.

Agency Response to a Union Request For Information Under Section 7114(b)(4) of the

Statute: Model Form for Use When Seeking Clarification of a Request or When

Communicating Countervailing Anti-disclosure Interests.

DATE: Date of the information request and date received by the agency. __________________

DATE: Date of the agency's response. ___________________ _

REQUESTER: Name of the requesting union. _________________________________________________

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AGENCY CONTACT: Name, position, mailing address and/or phone number of the

agency representative responding to the union request. _______________________________________

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UNION CONTACT: Name, position, mailing address and/or phone number of the union

representative to whom this response is being made. _________________________________________

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INFORMATION REQUESTED: Agency's understanding of the information requested.

(Include the time periods encompassed by the request and whether personal identifiers are being

requested or may be sanitized.) _______________________ ___________________________________

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ANTI-DISCLOSURE INTERESTS: Specific statements explaining any countervailing

anti-disclosure interests. ______ _________________________________________________________

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PRIVACY ACT: Is the requested information contained within a system of records under

the Privacy Act? If so, identify that system of records: _____________ ___________________________

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EMPLOYEE PRIVACY INTERESTS: If within a system of records, would the disclosure

of that information implicate privacy interests? If so, specifically describe the nature and

significance of those privacy interests. _____________________ ________________________________

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DISCLOSURE FORMAT: In what format is the agency willing to disclose the requested

information? (Include whether the agency would disclose the requested information with

personal identifiers deleted.) _______________________ _____________________________________

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PROHIBITED BY LAW: Is the requested information prohibited by law? (If so, identify

the specific provisions of that law and specifically explain why disclosure is prohibited by that

law.) ___________________________ _____________________________________________________

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NORMALLY MAINTAINED: Is the information normally maintained by the agency in

the regular course of business? (If not, specific statements explaining why the requested

information is not normally maintained.) ___________________________________________________

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REASONABLY AVAILABLE: Is the information reasonably available? (If not, specific

statements explaining why the requested information is not reasonably available,) _____ ___________

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STATUTORY EXEMPTION: Does the information constitute guidance, advice, counsel,

or training provided for management officials or supervisors, relating to collective

bargaining? (If it does, specific statements explaining why the requested information falls into

that category.) __________________________ _____________________________________________

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NEED FURTHER INFORMATION: The union request is not specific enough to permit

the agency to make a reasoned judgment as to whether the information must be disclosed

under the Statute. To make this determination, the agency requires specific answers to the

following questions: _______________ ____________________________________________________

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OTHER MATTERS: Other matters related to the request for information. (Discuss any

other matters not listed above which relate to the union's information request and which may

assist the union in understanding the agency's response.) _____________ ________________________

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The agency is willing to discuss the request, or a format or means of furnishing this

information to the union, or the issues giving rise to this request.