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Chief Privacy Officer/Chief FOIA Officer
U.S. Department of Homeland Security
245 Murray Drive SW, Building 410
Washington, D.C. 20528-0655

, January 31, 2014
Privacy/FOI Act Request

Dear FOI Officer,
This letter constitutes a request under the Privacy Act, 5 U.S.C. ยง552a.
I request copies of all information pertaining to myself contained in data processing systems operated by your
agency, including, but not limited to, any Passenger Name Record (PNR) data and Interagency Border Inspection
System (IBIS) data.
If the volume of the information disclosed exceeds the limit below which fees are waived, please contact me before
such expenses are incurred.
If you deny all or any part of this request, please cite each specific exemption that forms the basis of your refusal
to release the information and notify me of the appeal procedures available under the law.