If you are unable to print the Declaration of Identity for Freedom of Information and/or Privacy Act Requests form, or you choose not to use it, you will need to submit a written request that includes the following information:
Name, address, date of birth, social security number, employee identification number (if any), and your signature
The type of record(s) being requested
Any other information which you believe would help DOE to search and locate records, for example, dates of employment, names of the agency and/or company you worked for, etc.
A photocopy of two identifying documents bearing your name and signature, one of which shall bear your current home or business address and date of birth
A certification of identity. When you request access to records about yourself, you must verify your identity to protect the unauthorized disclosure of personal records. Your request must be signed and your signature must either be notarized or submitted by you under 28 USC 1746, a law that permits statements to be made under penalty of perjury as a substitute for notarization. The following information is required in your request: your full name, an acknowledgement that you understand the criminal penalty in the Privacy Act for requesting or obtaining access to records under false pretenses (5 USC 552a(I)(3)), and a declaration that your statement is true and correct under penalty of perjury (18 USC 1001).
You may submit your Privacy Act request the following ways:
1. By Mail:
U.S. Department of Energy
RL and ORP
Attention: Privacy Act Officer
P.O. Box 550, Mail Stop H5-20
Richland, Washington 99352
2. By Fax: (509) 376-9704, Attention: Privacy Act Officer
Email requests will not be accepted, as the request must be signed and the request must include the information as described above.