To: FOIA / Privacy Act Officer
Agency: Central Office FOIA/Privacy Act Office
Department: Department of Veterans Affairs
FOIA Contact: James P. Horan, Director FOIA
Service (005RIC) Department of
Veterans Affairs 810 Vermont
Avenue, NW Washington, DC 20420
Phone: (202) 632-7233
Re: Name of Veteran: ____________________________
VA Claim Number: _____________________________
Social Security Number: ________-______-__________
(Name of Veteran Here) _______________________.
I hereby request a copy of all documents contained in my Veterans Affairs “claims folder”,
to include, but not limited to;
- all documents in the right flap,
- all documents in the left flap and
- all documents in the center flap,
- as well as any temporary files including post it notes or any paper clipped additions.
Please forward the copied documents directly to me at the following address:
[Veterans address here]
_________________________ (street address)
As provided in the FOIA, please respond to this request within 20 (twenty) business-days.
I may be contacted at (Veterans Phone # here) (____) ____-________ if there are any questions.
Thank you for your assistance.
(Veterans Signature Here) _____________________________