Sample Privacy Act Denial of Access Appeal Letter

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

Re: Appeal of Denial of Privacy Act Access Request 

Dear : 

This is an appeal under the Privacy Act of the denial of my request for access to records. 

On (date), I requested access to records under the Privacy Act of 1974. 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 records that were withheld should be disclosed to me because ..... 

[Optional] Please consider that this appeal is also made under the Freedom of Information Act. Please provide any additional information that may be available under the FOIA. 

Thank you for your consideration of this appeal. 

Sincerely, 

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