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Privacy Act Request (5 U.S.C. 552a)

Federal & State Law Editorial TeamLast reviewed: April 2026

Request under the Privacy Act to access, amend, or obtain an accounting of disclosures of personal records maintained by a federal agency.

PDF TemplateUse the instructions below to complete this form

Instructions

Identify yourself with sufficient detail for the agency to locate your records (full name, date of birth, SSN if applicable). Specify the system of records you believe contains your information. State whether you seek access, amendment, or an accounting of disclosures. Include identity verification as required by the agency. The agency must respond within 10 business days.

This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.