Freedom of Information: Access to Records Application Form (FOI1)

• Published date: 11 August 2021
• Issuer: Department of Social Protection

Application form for

Access to Records

Part 1 Your own details

1. Your PPS No.:

3. Surname:

4. First name(s):

Mr. Mrs. Ms. Other

2. Title: (insert an ‘X’ or

specify)

6. Your address:

Contact Details

• Please answer all questions.

• Please use BLOCK LETTERS and place an X in the relevant boxes.

• For more information, log on to www.gov.ie.

• For us to locate the records in question, you should be as specific as possible

in identifying the records required. Generally no fees apply for personal records

unless a significant number of records are involved. If you wish to access records

regarding a specific claim or payment, you should specify this in your request. If it

isn’t possible to identify the records requested after a reasonable search has been

made, your request may be refused and you will be notified of this.

• If you are seeking access to the personal records of another person, you must

include their written consent.

Data Classification R

Social Welfare Services

FOI 1

7. Your telephone number:

L A N D L I N E

M O B I L E

County Postcode

8. If you are making this request on behalf of an organisation or company please state:

Name of organisation

or company:

Position you hold within the organisation or company: