REQUEST INFORMATION SHEET
TO: OFOISR ROOM 2C757, PENTAGON 2. CASE NO. 5. - 8. RECORD DESCRIPTIONS
5.a. DATE (YYYYMMDD) c. TYPE b. SECURITY CLASSIFICATION d. ADDRESSEE
SEE INSTRUCTIONS ON BACK This form is to be used for recording disclosure/ non-disclosure determination associated with processing a Freedom of Information or Privacy request. 4. COMPONENT SEARCH RESULTS
RECORD FOUND f. SUBJECT/TITLE NO RECORD
1. TYPE OF REQUEST
3. RECORD PROVIDED TO PROPONENT FOR REVIEW?
6.a. DATE (YYYYMMDD) c. TYPE
b. SECURITY CLASSIFICATION
7.a. DATE (YYYYMMDD) c. TYPE
b. SECURITY CLASSIFICATION
8.a. DATE (YYYYMMDD) c. TYPE
b. SECURITY CLASSIFICATION
9a. ACTION TAKEN BY COMPONENT
GRANT IN FULL GRANT IN PART DENY NO OBJECTION TO DISCLOSURE TRANSFER TO:
10. EXEMPTIONS INVOLVED FOR DENIALS (See 5 USC 552, 5 USC 552a, DoD Regulation 5400.7-R, and DoD Regulation 5400.11-R)
11. RATIONALE FOR DENIAL
a. NAME (Last, First, Middle Initial) b. OFFICE SYMBOL c. TELEPHONE NO. d. CONCUR
14. ACTION OFFICER
a. NAME (Last, First, Middle Initial) b. RANK c. TITLE d. SIGNATURE e. OFFICE TELEPHONE NUMBER
15. APPROVAL/DENIAL AUTHORITY
a. NAME (Last, First, Middle Initial) b. RANK c. TITLE d. SIGNATURE e. DATE (YYYYMMDD)
SD FORM 472, APR 2004
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional 7.0
General note for personnel preparing or processing this report: Coding must be as indicated in the instructions. In cases where specific coding instructions are not provided, reference must be made to the Department of Defense Manual for Standard Data Elements, DoD 5000.12-M. Noncompliance with either the coding instructions contained herein or those published in referenced manual will make the organization which fails to comply responsible for required concessions in data base communication. Items marked with an asterisk (*) have been registered in the DoD Data Element Program. *1. TYPE OF REQUEST - OFOISR will notate whether request is an initial or appeal action by placing an "x" in the appropriate block. *2. CASE NO. - OFOISR will assign request case number using F = Freedom of Information, and P = Privacy. A consecutive numbering system is employed for tracking purposes; e.g., 04-F-0000. This notation shall be used on all forms and/or correspondence associated with request. *3. RECORD PROVIDED TO COMPONENT TO REVIEW - In instances where a record is provided to a Component by OFOISR for review, OFOISR will place an "x" in this block. *4. COMPONENT SEARCH RESULTS - Upon receiving a request, Component Action Officer(s) will conduct a search for requested records and indicate the results of that search by placing an "x" in the appropriate block. Ignore this requirement if block #3 is marked. 5. - 8. RECORD DESCRIPTION - When records are found responsive to the request, the Component Action Officer shall complete blocks 5a through 5f. In instances where voluminous records are involved, a separate sheet may be attached detailing required information. *a. DATE - Enter date of located record. b. TYPE - Identify record type; e.g., memorandum, letter, study, message, etc. *c. SECURITY CLASSIFICATION - Enter record classification using T = Top Secret, S = Secret, and C = Confidential. Records bearing a "FOR OFFICIAL USE ONLY" marking = FOUO. d. ADDRESSEE - Enter information such as individual's name, title or organization which reflects to or for whom record was intended. e. ORIGINATOR - Enter information such as individual's name, title or organization which reflects record's origin. f. SUBJECT/TITLE - Record identification should be as complete as possible. Where a record is commonly known by a name other than its official subject/title, both references should be notated, e.g., 1968 Department of Defense Study, "United States Vietnam Relations, 1945 1967," popularly known as the Pentagon Papers.
9. ACTION TAKEN BY COMPONENT - Upon acceptance of a request for action and content of located record has been reviewed, mark appropriate block in #9a to indicate decision made. A record described in block #5 (and on any supplemental sheets thereto) which are denied by the Component shall be identified by placing an asterisk behind the subject/title. *a. Mark GRANT IN FULL when all records reviewed may be disclosed; mark GRANT IN PART when any record or portion of any record is denied; mark DENY when all records may not be disclosed; mark NO OBJECTION TO DISCLOSURE when entire record is not under your jurisdiction, but there is no objection by your Component to disclosure. Mark TRANSFER TO if request is misdirected and indicate recommended addressee in block 9b. *10. EXEMPTIONS INVOKED FOR DENIALS - Identify one or more of the exemptions to disclosure invoked when denying a record or a portion of a record. When either GRANT IN PART or DENY is marked, the exemption number(s) must be cited. 11. RATIONALE FOR DENIALS - Component's rationale for denying a record or a portion of a record shall be entered to include the legitimate governmental purpose served in withholding. Classified comments, if required, will be placed in a separate memorandum to OFOISR. 12. REMARKS - Any additional pertinent information associated with the request may be entered. If applicable, a statement that reasonably segregable portions of a denied record cannot be provided will be entered. 13. COORDINATION - Reflect all parties which reviewed records in the course of arriving at or passing on the determinations. When either GRANT IN PART or DENY is marked, coordination with Component's General Counsel is mandatory. a. OFFICE SYMBOL - Self explanatory. *b. NAME - Self explanatory. c. TELEPHONE NO. - Self explanatory. *d. CONCUR - Place an "X" in this box to indicate concurrence. *e. NON-CONCUR - Place an "X" in this box to indicate non-concurrence. 14. ACTION OFFICER - Identification of Component action officer allows direct contact on any subsequent matters. *a. b. c. d. e. NAME - Self explanatory. RANK - Self Explanatory. TITLE - Self explanatory. SIGNATURE - Self explanatory. OFFICE PHONE NO. - Include area code.
15. APPROVAL/DENIAL AUTHORITY - The specifically appointed authority is encouraged to review action on all requests. The authority's signature denotes personal review. Signature is mandatory when GRANT IN PART, DENY or NO RECORD is marked. *a. b. c. d. *e. NAME - Self explanatory. RANK - Self explanatory. TITLE - Self explanatory. SIGNATURE - Self explanatory. DATE - Self explanatory.
SD FORM 472 (BACK), APR 2004