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Annotated Individual Request


January 31, 2023[IH1] 


Federal Bureau of Investigation
Attn: Initial Processing Operations Unit
Record/Information Dissemination Section
200 Constitution Drive
Winchester, VA 22602
Fax: (540) 868-4997

U. S. Department of State
Office of Information Programs and Services
2201 C Street N.W., Suite B266
Washington, D.C. 20520-0000

Central Intelligence Agency
Information and Privacy Coordinator
Central Intelligence Agency
Washington, D.C. 20505

U.S. Department of Homeland Security
Chief Privacy Officer/Chief FOIA Officer
The Privacy Office

245 Murray Lane SW [IH2] 
Washington, D.C. 20528-0655




Re: Freedom of Information Act Request


To the Freedom of Information Officer:

This is a request under the Freedom of Information Act, 5 U.S.C. § 552 ("FOIA"), and the Privacy Act, 5 U.S.C. § 552a, by My Name [IH3] to the Federal Bureau of Investigation (“FBI”), Central Intelligence Agency (“CIA”), Department of State(“State”), and the Department of Homeland Security (“DHS”)[IH4]  for any and all records related to Ms. Name. Please refer this request to all appropriate subcomponents, offices, and other custodians within each agency.[IH5] 


A. Personal Information

The following information should be used in identifying the records requested:

Full name: My Name
Other names by which Name has been known: My Full Name
Date of Birth: February 29, 1980
Place of Birth: New York City
Social Security Number: 123-456-7890
U.S. Passport # 1234567
Current address: 123 Activist Ave., Bronx, New York 11111[1][IH6] 

Ms. Name also makes this request under the Privacy Act, 5 U.S.C. § 552a. Ms. Name consents to the disclosure pursuant to this request of personal information relating to herself. Appropriate forms signed by Ms. Name are attached to this request as Attachments 1-3. [IH7] 


B. Background Information[IH8] 

In 2005, Ms. Name received document productions in response to a similar FOIA request from DHS indicating the agency had her name on several lists of “known activists.” None of the records she received at that time indicated surveillance of her and her activities had ceased. Nor were those limited documents necessarily the extent of the records kept on Ms. Name during that period. Examples of the documents previously released to Ms. Name are attached to this request.


C. Request for Information[IH9] 

My Name requests disclosure of any and all RECORDS[2] [IH10] as stated below:

  1. Any RECORDS relating to investigations[IH11]  conducted by any office, component or division, and/or individual agent(s), of the FBI, the CIA, the DHS or State that references or relates to My Name between January 1, 2021[IH12]  and December 31, 2023;[3]
  2. Any RECORDS of communication(s) between any person working for any component, office or division[IH13]  of the FBI, CIA, DHS or State with any other U.S. government agencies, including state or local agencies, between January 1, 2021 and December 31, 2023, that references or relates to My Name
  3. Any RECORDS relating or referring to My Name, including, but not limited to, RECORDS that document any collection of information about, monitoring, surveillance, observation, questioning, interrogation or investigation [IH14] of My Name or her ACTIVITIES[4][IH15] ;

    In addition, I ask that agencies prioritize the processing and production of any records relating to requests #4 - 12 below. Note that this should not preclude agencies from searching for the records specified in requests #1-3 of this FOIA request.[IH16] 
  4. Any records or communications related to My Name’s ACTIVITIES in regards to Palestine, the Palestinian government, travel to or from Palestine, or anything else related, but not limited, to:
    1. Participation in the “Gaza Flotilla” in 2010.
    2. The delegation to Conference on Gaza in 2016.
  5. Any records or communications related to the June 1, 2018 March Against Trump, held in New York City, NY.
    1. This includes any records or communications beginning in August of 2017 when organizing for the March Against Trump started, as well as the day of the March itself.[IH17] 
  6. Any records or communications related to Name’s work with and in support of the Movement for Black Lives from 2016-2019. This includes, but is not limited to:
    1. Records related to her involvement with MBL New York demonstrations organized in 2016.

D. Format of Production[IH18] 

With respect to the form of production, see 5 U.S.C. § 522(a)(3)(B). Please search for responsive records regardless of format, medium, or physical characteristics, and including electronic records. Please provide the requested document in the following format:

  • Saved on a CD, CD-ROM, or DVD;
  • In PDF or TIF format wherever possible;
  • Electronically searchable text wherever possible;
  • Each paper record in a separately saved file;
  • “Parent-child” relationships maintained, meaning that the requestor must be able to identify the attachments with emails;
  • Any data records in native format (i.e. Excel spreadsheets in Excel);
  • Emails should include BCC and any other hidden fields;
  • With any other metadata preserved.


E. Request for Fee Waiver [IH19] 

I am entitled to a fee waiver pursuant to 5 U.S.C. § 552(a)(4)(A)(iii) on the grounds that "disclosure of the requested records is in the public interest because it is likely to contribute significantly to the public understanding of the activities or operations of the government and is not primarily in the commercial interest of the requester." 5 U.S.C. § 552(a)(4)(A)(iii). I meet the requirements for a fee waiver because the subject of the request concerns the operations or activities of the government, the disclosure of the information is likely to contribute to a significant public understanding of government operations or activities, the Requesters’ primary interest is in disclosure, and they have no commercial interest in the information. See 6 C.F.R. § 5.11(b); 22 C.F.R. § 121.16(a); 28 C.F.R. § 16.10(k); 32 CFR § 1900.13(b).[IH20] 

I have spent the past 15 years dedicated to educating the public and advocating for civil rights and human rights, and have undertaken this work in the public interest and not for any private commercial interest. Similarly, the primary purpose of this FOIA request is to obtain information to further the public's understanding of how federal agencies have and continue to conduct surveillance of and their treatment of First Amendment-protected organizing. Access to this information is crucial for myself and my community partners, and will be used to evaluate government procedures and actions, as well as their potential detrimental effects.

I have no commercial interest in the requested information. [IH21] Disclosure in this case, therefore, meets the statutory criteria, and a fee waiver would fulfill Congress’ legislative intent in amending FOIA. See Judicial Watch Inc. v. Rossotti, 326 F.3d 1309,1312 (D.C. Cir. 2003) (“Congress amended FOIA to ensure that it be ‘liberally construed in favor of waivers of noncommercial requesters.’”)(citing McClellan Ecological Seepage Situation v. Carlucci, 835 F.2d 1282, 1284 (9th Cir. 1987)).

In the alternative, if no fee waiver is granted and the fees exceed $100.00[IH22] , please contact me to obtain consent to incur additional fees. Processing fees should be limited pursuant to 5 U.S.C. § 552(a)(4)(A)(ii)(II) (“[F]ees shall be limited to reasonable standard charges for document duplication when records are not sought for commercial use and the request is made by ... a representative of the news media.”).


F. Expedited Processing[IH23] 

I am entitled to expedited processing of this request because there is a “compelling need” for the information. 5 U.S.C. § 552(a)(6)(E)(i)(I). A “compelling need” is established when there exists an “urgency to inform the public about an actual or alleged Federal Government activity,” when the requester is a “person primarily engaged in disseminating information.” See 6 C.F.R. § 5.5(d)(ii); 32 CFR § 1900.34(a); 22 CFR § 171.11(f); 28 C.F.R. § 16.5(e)(ii).

In my work, I am significantly engaged in disseminating information and community advocacy in support of fundamental civil rights, and have a proven track-record of compiling and disseminating information and reports to the public about government functions and activities. [IH24] Furthermore, I will also disseminate any records released to the public for no cost as well.[IH25] 

In addition, the agencies grant expedited processing where the subject of the request is a “matter of widespread and exceptional media interest in which there exist possible questions about the government's integrity that affect public confidence.” 28 C.F.R. § 16.5(e) (iv). As I, My Name, have continued my organizing efforts within social change movements, I am often called on as an expert to explain what the obstacles have been to securing policy changes from the federal government. It has often been difficult to understand how the actions of federal agencies, and more specifically agencies involved in policing, law enforcement and national security concerns have impacted on the internal workings of U.S. social movements. I have the right to know what federal agencies (as well as state and local agencies) have done in terms of monitoring my actions as an individual and as part of various organizations and projects. The sooner we obtain this information, the more not only myself but the individuals and organizations I work with can begin to have a fuller understanding of how these parts of the federal government have watched their activity and might have used information they obtained in ways that undermined their work.

G. Response

I expect a determination of this request by each agency for records within 20 days, as provided by statute. See 5 U.S.C. § 552(a)(6)(A)(i).

If my request is denied, in whole or in part, I ask that each agency justify all deletions by reference to specific exemptions to FOIA. I also expect each agency to release all segregable portions of otherwise exempt material. I reserve the right to appeal each agency’s decision to withhold any information.[IH26] 

Thank you for your prompt attention to this matter. Please furnish all applicable records to: My Name, at [email protected] (preferred) or by mail at My Name, My Address; (222) 222-2222. [IH27] 


I certify that the above information is true and correct to the best of my knowledge. [IH28] 




My Name

[email protected] (preferred)