Sample Privacy Act Request To Amend Records Letter

Privacy Act Officer [or System of Records Manager] 
Name of Agency 
Address of Agency 
City, State, Zip Code 

Re: Privacy Act Request to Amend Records 

Dear : 

This is a request under the Privacy Act to amend records about myself maintained by your agency. 

I believe that the following information is not correct: [Describe the incorrect information as specifically as possible]. 

The information is not (accurate) (relevant) (timely) (complete) because .... 

[Optional] Enclosed are copies of documents that show that the information is incorrect. 

I request that the information be [deleted] [changed to read:]. 

Thank you for your consideration of this request. 

Sincerely, 

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