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PRIVACY ACT REQUEST
VIA FACSIMILE & CERTIFIED MAIL (Return Receipt Requested)
DEPARTMENT OF VETERANS AFFAIRS CLAIMS INTAKE CENTER
PO BOX 4444
JANESVILLE, WI 53547-4444
Fax to: TOLL FREE: 844-531-7818
July 15, 2018
RE: PRIVACY ACT REQUEST
VA File No (SSN): xxx-xx-xxxx
Veteran Social Security #: xxx-xx-xxxx
To Whom it May Concern:
This is a request for documents under the Privacy Act, 5 U.S.C. § 552a, (PA) on behalf of INSERT NAME(Veteran). This request is properly made via facsimile as it contains the signature of the requester.
- IDENTIFICATION OF DOCUMENTS. I hereby request all documents contained in my VA claims folder for any of Veteran INSERT NAME VA claims, AND, to include anything in the VA Virtual File, Virtual Records, or any electronic system where records about me or my claim are kept or stored.
- I understand that if I am seeking my Department of Veterans Affairs Medical Center records, I will contact that Medical Center.
- FORM/FORMAT IN WHICH TO PRODUCE INFORMATION. The PA and the VA’s own internal policies related to PA requests, require that the records be produced in the format sought by the requester, if the record is readily reproducible in that form or format.
· Please provide my records (on a CD or in Paper). I understand my records are now in the electronic format and at times the copies maybe hard to read due to the condition my record was at the time of scanning. Please take special care to ensure that both sides of any two-sided documents produced in response to this request are included in the response, and are scanned into a PDF in such a way that they do not “bleed-through” from one side of the document to the other.
4. TIME FOR RESPONSE. Please note that this request for documents is being made pursuant to the Privacy Act, 5 U.S.C. § 552, as well as 38 C.F.R. §1.550 and 38 C.F.R. § 1.577. Your agency has a duty to respond to this request within TWENTY (20) BUSINESS DAYS of the date of this request pursuant to 5 U.S.C. § 552 (a)(6)(A)(2)(i).
Additionally, although an extension of time to respond may be requested, it may only be granted for “unusual circumstances.” “Predictable agency workload” is not typically considered an unusual circumstance as stated in 5 U.S.C. § 552(a)(6)(C)(ii). Moreover, even to the extent that unusual circumstances could be demonstrated in this instance, the time limit for the extension is limited to “10 working days” pursuant to 38 C.F.R. § 1.553(d).
Please also be aware that your agency’s failure to respond to this request within twenty business (20) days can result in the filing of an administrative appeal with the office of the Secretary of the Department of Veterans Affairs pursuant to 38 C.F.R. § 1.557 and 5 U.S.C. § 552(a)(6)(A)(2) (ii), and/or, the filing of a federal lawsuit to compel the production of the information. In any such appeal or lawsuit, I intend to seek not only injunctive and/or monetary relief related to this request, but to the extent permitted by law, injunctive and/or monetary relief based on the Department of Veteran’s Affairs patterns and/or practices of responding to PA requests in a manner violative of the PA, as well as attorney fees and litigation expenses, and any other remedy/relief available at law.
5. Point of Contact. As discussed above, please respond to this request within twenty (20) business days. I may be contacted at Insert PHONE# or EMAIL. My address is INSERT ADDRESS.
Thank you very much in advance for your assistance.
INSERT SIGNATURE & NAME (MUST be signed)
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PRIVACY ACT REQUEST VIA FACSIMILE & CERTIFIED MAIL (Return Receipt Requested) DEPARTMENT OF VETERANS AFFAIRS CLAIMS INTAKE CENTER PO BOX 4444 JANESVILLE, WI 53547-4444 -or- Fax to: TOLL FREE: 844-531-7818 July 15, 2018 RE: PRIVACY ACT REQUEST Veteran: Name VA File No (SSN): xxx-xx-xxxx Vetera...