Response

Freedom of Information Request Form
Customer Service: (803) 898-8137

Contact Information

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip

Work Phone

Company/Organization

I'm requesting:Specific documents
File review

Facility or project name:

Facility address:

County

DPH file custodian/staff contact if known:

Description of document or files requested:

Family Privacy Protection Act Statement

The Family Privacy Protection Act, SC Code Section 30-2-50, prohibits any person or private entity from knowingly obtaining or using any personal information obtained from our agency for commercial solicitation directed to any person in the State. Violation of this law is a crime.

I have read and understand this statement. I am not requesting this information for the purposes of commercial solicitation in violation of the law.I Agree.

Submit requests: Email: FOI@dph.sc.gov - Fax: (803) 898-3367 - Mail: FOI, P.O. Box 2046, West Columbia, SC 29171

Instructions for Completing 2295-ENG-DPH

Purpose: This form is used to obtain records under of the SC Freedom of Information Act.
Audience: Any person seeking review or copies of public records of the Department.
Instructions:

Fill out the top portion of the form by providing complete contact information. We may contact you to obtain additional information necessary to fulfill your request. Please provide a telephone number where you can be reached between 8:30 a.m. to 5 p.m., Monday through Friday.
Provide as much information about the desired documents as possible.
Read and sign the Family Privacy Protection Act statement.

Submit the form: Email (FOI@dph.sc.gov), fax (803-898-3367) or mail (FOI, P.O. Box 2046, West Columbia, SC 29171) completed form to the FOI Office.

Contact Information
For additional information, contact the:
Freedom of Information Center
South Carolina Department of Public Health (DPH)
P.O. Box 2046, West Columbia, SC 29171
(803) 898-8137

Personal information provided in this document is subject to public scrutiny or release.

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