Name of applicant

If the applicant is requesting info on behalf of a 3rd party, 3rd party’s name #1

Address for the information to be sent to

E-mail

Phone

Date of request

Information requested

Preference of form/format of the information

Response date (20 working

days after request)

Request taken by

Request passed to/dealt with by

Has all the information been disclosed?

#1  For example the Citizens Advice Bureau may apply for information on behalf of an individual, and request that the information is sent to the 3rd party direct.

Is there any charge for the

information, and if so, how

much, and is advanced payment required?

Has the response date been extended because the information is complex or voluminous, if so what is the new date?

Have any 3rd party

organisations been

consulted, and if so who?

Have you transferred part/all of the request, and if so which part and to who?

What advice or assistance

has been given to the

applicant?

Attach copies of any appropriate correspondence/phone logs e.g.

• Consultation with 3rd party organisations

• Requesting payment from the applicant

• Final response, including explanation and justification of any

information withheld, and appeal rights