Application Public Access Form PDF Details

Accessing records held by public agencies can often seem like a daunting process, but understanding the right procedure can significantly simplify it. The Application for Public Access to Records for Suffolk County Department of Health Services is a key form in this process, designed to facilitate public access to records under the Freedom of Information Law. This form requires applicants to provide detailed information about the records they seek, including descriptions, relevant dates, and, if applicable, complete tax map numbers for property-related records. It outlines a step-by-step process where applicants can choose to either inspect or receive copies of the documents they are interested in. The form further segments into parts that are handled by the applicant and the Freedom of Information Officer, who then makes a determination on the application. Approved requests lead to arrangements for record inspection or copying, while denials can be appealed to the Office of the County Attorney. Charges applicable for reproducing documents are also addressed. This comprehensive approach ensures transparency and accessibility, emphasizing the right of individuals to access public records, and detailing the procedural aspects from application submission to the response from the agency.

QuestionAnswer
Form NameApplication Public Access Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesfoil form suffolk, form wwm, foil suffolkcountyny, wwm074

Form Preview Example

APPLICATION FOR PUBLIC ACCESS TO RECORDS Suffolk County Department of Health Services

For office use only

Date:

Office(s):

Tracking #:

INSTRUCTIONS TO APPLICANT: Please complete Section I of this form. Do not leave any areas blank. Mail or fax a completed application to the Freedom of Information Officer listed below.

SECTION I: To be completed by Applicant.

Date of Application: _____________Applicant Represents: ___________________________________

Applicant's Name (Please print):_________________________________________________________

Applicant's Address: __________________________________________________________________

Applicant's Phone #: __________________________ Applicant's Email: _________________________

Applicant’s Signature: _________________________________________________________________

Describe the record sought and if in regard to a property include a complete tax map number (District, Section, Block & Lot in the proper format). Supply all relevant information that will help locate the record desired: date(s), a file title, reference number, the physical address, and property type (commercial/residential/subdivision).

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

I HEREBY APPLY TO:

OInspect the following record

OReceive a copy of the following document(s)

PROVIDE REQUEST TO:

Acting Freedom of Information Officer: Michelle Rosen

Agency Name: Suffolk County Department of Health Services Address: 3500 Sunrise Highway, Suite 124

Post Office Box 9006

Great River, NY 11739-9006 Fax #: 631-854-0156

SECTION II - For use by Freedom of Information Officer (or designee) only

OApproved. Call to arrange an appointment to inspect the requested record.

Contact Person:

_____________________________

Phone #: _____________________

ORecords not possessed or maintained by this agency.

ORecords cannot be found after diligent search.

ODenied. Reason for denial: _______________________________________________________

ODocument(s) enclosed as requested.

OReceipt of this request is acknowledged. There will be a delay in supplying the requested record until payment of reproduction fee is received. The following fee applies $ _____________

OOther: ________________________________________________________________________

Signature: ______________________ Title: _________________

Date: __________________

Section III - Notice to applicant

You have the right to appeal a denial of this application in writing to the Office of the County Attorney within 30 days of the denial. Information as to the person to contact is shown below. The contacted person must respond to you in writing within ten business days of receipt of your appeal.

Suffolk County Attorney

H. Lee Dennison Bldg., 6th floor

100 Veterans Memorial Highway Hauppauge, NY 11788

Business Telephone: (631) 853-4049

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1. The application public access records will require particular information to be entered. Ensure that the following blanks are completed:

suffolk county foil request form conclusion process shown (step 1)

2. The subsequent stage is usually to fill in these particular blanks: Describe the record sought and if, Inspect the following record, o o Receive a copy of the, PROVIDE REQUEST TO Acting Freedom, Post Office Box Great River NY , Agency Name Suffolk County, SECTION II For use by Freedom of, o Approved Call to arrange an, Contact Person, Phone , o Records not possessed or, record until payment of, Signature Title Section III , and Date .

Writing section 2 of suffolk county foil request form

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