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Run: FOIA Response Determination Letter Template

Document a FOIA determination letter with request details, release and withholding decisions, applied exemptions, and appeal rights in one reviewable record.

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Request and Case Identification

FOIA Request ID (required)

Request Received Date (required)

Requester Name (required)

Requester Email

Optional if the response will be sent by mail or another approved channel.

Response Delivery Method (required)

Determination Summary

Determination Type (required)

Determination Date (required)

Records Reviewed (required)

Briefly describe the records searched or reviewed. Use minimum necessary detail.

Number of Responsive Pages or Records

Release and Withhold Decision

Disposition for Responsive Records (required)

Pages or Records Released

List page ranges, record identifiers, or file names released to the requester.

Pages or Records Withheld

List page ranges, record identifiers, or file names withheld or withheld in part.

Redaction Summary

Describe the portions redacted and the reason for redaction at a high level.

Referred Office or Agency

Applied Exemptions

Applied Exemptions (required)

Exemption Rationale (required)

Explain, in plain language, why each exemption applies. Avoid unnecessary PII and include only the minimum necessary detail.

Segregability Review Completed

Confirm whether a segregability review was completed to determine if any reasonably segregable portions could be released.

Yes No N/A

Appeal Rights and Next Steps

Appeal Rights Included in Letter (required)

Confirm that the determination letter includes the requester’s appeal rights and deadline.

Yes No N/A

Appeal Deadline (Days)

Number of days the requester has to appeal, if applicable.

Appeal Instructions

Summarize where and how the requester may submit an appeal.

Fee or Cost Notice

Include any fee assessment, waiver, or cost-related notice if applicable.

Approval and Audit Trail

Prepared By (required)

Reviewed By

Approved By (required)

Letter Issue Date (required)

Final Determination Letter File

Upload the final signed determination letter, if retained in the case file.

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Email (required)

Your name (optional)

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