FREEDOM OF INFORMATION LAW REQUEST FORM
FREEDOM OF INFORMATION LAW REQUEST FOR DMV RECORDS
MAKE SURE YOU USE THE CORRECT FORM TO REQUEST RECORDS!
You will receive your records more quickly when you use the correct request form. DMVforms are available at dmv.ny.gov
STOP DO NOT USE THIS FORM TO REQUEST THE FOLLOWING RECORDS:
Driver license record (“abstract”) - use form MV-15 |
Vehicle title record - use form MV-15 |
Driver history (“lifetime abstract”) - use form MV-15 |
Copy of a ticket and/or ticket disposition - use form MV-15 |
Vehicle registration record (“abstract”) - use form MV-15 |
Copy of a revocation or suspension order - use form MV-15 |
Accident report - use form MV-198C |
|
1. InformationAbout You (the Requestor):
Name
Organization (ifapplicable)
Address (NumberandStreet)
E-mailAddress (Requiredifyouwantyourrecordssenttoyouelectronically)*
Phone Number (optional)
()
*Records sent by email or by fax will not be certified. Certified records must be mailed. We can only provide your records by one method (mail, email, or fax).
2. Important InformationAbout Requests for Certain DMV Records:
Personal information on certain DMV records is protected by the Federal Driver’s Privacy ProtectionAct (18 U.S.C. §2721 et seq.) and by §87 and §89 of the NYS Public Officers Law. Records about a driver license or permit, motor vehicle title, motor vehicle registration, or identification card issued by DMV are protected by the Driver’s Privacy ProtectionAct.
If any of the records you want are protected by the Driver’s Privacy ProtectionAct, you must do the following:
1.Mark your permissible use in the list on page 3 of this form;
2.Send a photocopy of your driver license or government-issued non-driver ID card with this form(you can cover the photo on the document); and
3.Sign the certification on the bottom of page 3.
MV-FOIL(12/19)
PAGE 1 OF 3
FREEDOM OF INFORMATION LAW REQUEST FORM
3. Describe the DMV Records That You Want:
Please provide a clear description of the record(s) you are requesting with as much detail as possible.
YOU CANNOTUSE THIS FORM TO REQUESTYOUR LIFETIMEABSTRACT.YOU MUST USE FORM MV-15!
4. Fee Information:
Section202oftheNYSVehicleandTrafficLawrequiresa$10searchfeeandacopyfeeof$1perpage.Youmustsenda$10searchfeewith your FOILrequest, unless you or your organization is exempt from these fees.
Only these groups are exempt from search fees:
Government agencies
Volunteer fire companies
Volunteer ambulance services
Public officers, boards, or bodies
Legal aid bureaus or societies or other private entities when acting pursuant to §722 of the NewYork State County Law
5. Method of Payment (DO NOT SEND CASH):
Check the box that shows your payment method.
oExempt (Check this box ONLYif you belong to one of the exempt groups described in the Fee Information section above.)
oCheck
Make checks payable to the “Commissioner of Motor Vehicles”
Please remember to SIGN YOUR CHECK
No starter checks
U.S. Funds only
oMoney Order
oDMV EscrowAccount:
List of Permissible Uses - Driver Privacy ProtectionAct
èStep 1)Check the permissible use(s) for the records that you want:
TheFederalDriver’sPrivacyProtectionAct(18U.S.C.§2721.etseq.)(“DPPA”)regulatesaccesstoMotorVehiclesrecords.Recipientherebycertifiesthatthe informationprovidedhereunderbyDMVshallbeusedsolelyforthefollowingpurpose(s).
(Recipient must check all that apply.)
1.Useinanycivil,criminal,administrative,orarbitralproceedinginanycourtoragency,includingtheserviceofprocess,investigationin anticipationoflitigation,andtheexecutionorenforcementofjudgmentsandordersorpursuanttoacourtorder.(18U.S.C.§2721(b)(4))
2.Use by an insurer or insurance support organization or self-insured entity in claims investigations, anti-fraud activities, rating or under- writing activities. (18 U.S.C. §2721 (b)(6))
3.Use in providing notice to the owners of towed or impounded vehicles. (18 U.S.C. §2721 (b)(7))
4.Use by an employer, its agent or insurer to obtain information relating to the holder of a commercial driver's license required under Chapter 313 ofTitle 49 of the U.S.C. (18 U.S.C. §2721 (b)(9))
5.For use in the normal course of business by a legitimate business or its agents, employees, or contractors, but only-
(A)to verify the accuracy of personal information submitted by the individual to the business or its agents, employees, or contractors; (18 U.S.C. §2721 (b)(3)(A)) and
(B)if such information as so submitted is not correct or is no longer correct, to obtain the correct information, but only for the purposes of preventing fraud by, pursuing legal remedies against, or recovering on a debt or security interest against, the individual. (18 U.S.C. §2721 (b)(3)(B))
6.Use required under NYSVehicle andTraffic Law,Article 19A- Special Requirements for Bus Drivers. (18 U.S.C. §2721 (b)(14))
7.Use required under NYSVehicle andTraffic Law,Article 19B - Special Requirements for Commercial Motor Carriers.
(18 U.S.C. §2721 (b)(14))
8.Use by any government agency, including any court or law enforcement agency, in carrying out its functions. (18 U.S.C. §2721 (b)(1))
9.Use by any private person or entity acting on behalf of a federal, state, or local agency in carrying out its functions. (18 U.S.C. §2721 (b)(1))
10.Use in matters of motor vehicle or driver safety. (18 U.S.C. §2721 (b)(2))
11.Use in matters of motor vehicle theft. (18 U.S.C. §2721 (b)(2))
12.Use in matters of motor vehicle emissions. (18 U.S.C. §2721 (b)(2))
13.Use in matters of motor vehicle product alterations, recalls or advisories. (18 U.S.C. §2721 (b)(2))
14.Use in performance monitoring of motor vehicles, motor vehicle parts and dealers. (18 U.S.C. §2721 (b)(2))
15.Use in motor vehicle market research activities, including survey research. (18 U.S.C. §2721 (b)(2))
16.Use in removal of non-owner records from the original owner records of motor vehicle manufacturers. (18 U.S.C. §2721 (b)(2))
17.Use in the operation of private toll transportation facilities. (18 U.S.C. §2721 (b)(10))
18.For use by any requester, if the requester demonstrates it has obtained the written consent of the individual to whom the information pertains. (May use form MV-15GC). (18 U.S.C. §2721 (b)(13))
19.Use specifically authorized under NYS law, IF such use is related to the operation of a motor vehicle or public safety.
Cite the specific NYS law here: |
|
(18 U.S.C. §2721 (b)(14)) |
20.Use in research activities and in producing statistical reports, as long as the personal information is not published, disclosed or used to contact individuals. (18 U.S.C. §2721 (b)(5))
Toknowinglymakeafalsestatementorconcealamaterialfactinthiswrittenstatementmaybepunishableasacriminaloffense.Inaddition,anyonewhomakes falserepresentationtoobtainanypersonalinformationfromanindividual’sMotorVehiclesrecordissubjecttofederalcriminalfinesundertheDriver’sPrivacy ProtectionAct(DPPA).
èStep 2)Attach a copy of your driver license or government-issued identification card. (Youmaycoverthepicture.)
èStep 3)Sign the following Privacy Certification:
I certify that I have read the Driver’s Privacy ProtectionAct (18 U.S.C. §2721 et seq.) and will comply fully with the terms of such law. I also certify that I shall notrequestoruseanyinformationprovidedbytheDepartmentofMotorVehiclesthatisnotspecificallyauthorizedbytheDriver’sPrivacyProtectionAct.
I certify that if I receive or have access to records or information from the DMV, I shall not (i) use such records or information for civil immigration purposes or
(ii)disclose such records or information to any agency that primarily enforces immigration law, such as U.S. immigration and customs enforcement and U.S. customsandborderprotection,ortoanyemployeeoragentofanysuchagencyunlesssuchdisclosureispursuanttoacooperativearrangementbetweencity,state andfederalagencieswhichdoesnotenforceimmigrationlawandwhichdisclosureislimitedtothespecificrecordsorinformationbeingsoughtpursuanttosuch arrangement.Icertifythat,inadditiontotherequirementsof18USC2721(c),Ishallkeepforaperiodoffiveyearsrecordsofallusesandidentifyingeachperson orentitythatprimarilyenforcesimmigrationlawthatreceiveddepartmentrecordsorinformationfromsuchcertifyingpersonorentity.Ishallmaintaintherecords inamannerandformprescribedbythecommissioner,andIshallmakethemavailableforinspectionuponthecommissioner’srequest.
X
Requester’s Signature (required)Date
Requester - PrintNameHere
MailyourrequesttoNEWYORKSTATEDEPARTMENTOFMOTORVEHICLES,FREEDOMOFINFORMATIONLAWOFFICE,6 EMPIRE STATE PLAZA, ROOM 136B,ALBANYNY12228. Or send it via email to dmv.sm.foil@dmv.ny.gov.
MV-FOIL(12/19) |
dmv.ny.gov |
RESET/CLEAR |
PAGE 3 OF 3 |
|
|
|
