Standard Right-to-Know Law Request Form

Standard Right-to-Know Law Request Form
Please read carefully. Complete this form and retain a copy of both pages; this copy may be required if an appeal is filed. You have 15 business days to appeal after a request is denied or deemed denied. More information about the RTKL is available at https://www.openrecords.pa.gov. In most cases, a completed RTKL request form is a public record.
Submitted to Agency Name:*
Attn: AORO
Date Request Submitted:*

MonthDayYear
EmailU.S. MailFaxIn Person
PERSON MAKING REQUEST:
Name*

First NameLast Name
Company (if applicable):
EmailU.S. Mail
If you wish to obtain records that only exist in hard copy, or must be provided on an electronic storage device, you may be required to provide a mailing address to the agency. See Section 703.
Email*

Confirmation Email
Telephone:
Format: (000) 000-0000.
Mailing Address*
Street Address
City
State
Zip code
EmailTelephoneU.S. Mail
REQUESTER AFFIRMATION:
RECORDS REQUESTED:
What records are you requesting? Provide as much detail as possible, including subject matter, time frame, and type of record sought. RTKL requests must seek records, not ask questions. Use additional pages if necessary.*
Yes, printedYes, electronicNo, in-person inspection
Records shall be provided in the medium requested if they exist in that medium; otherwise, they shall be provided in the medium in which they exist. See Section 701. Your request may require payment or prepayment of fees. View the Official RTKL Fee Schedule for more details.
$100Other amount
Yes (may be subject to additional costs)No
Certifying Records Under the RTKL
Internal Response
Date Received

YearMonthDay
YesNo
30 day extension due date

MonthDayYear
Actual response date

MonthDayYear
GrantedPartially Granted & DeniedDenied
Cost to Requester
Appropriate third parties notified and given an opportunity to object to the release of requested records.
File Upload

Cancelof
RTK Email
Right to Know Officer
Should be Empty:

Standard Right-to-Know Law Request Form

PERSON MAKING REQUEST:

REQUESTER AFFIRMATION:

RECORDS REQUESTED:

Internal Response