TBC 350-57 (Rev. 1997/11)
Government Gouvernement of Canada du Canada
Access to
Information Act
Access to
Information
Request
Form
Protected when completed
For official use only
Step 1
Determine which federal government institution is most likely to have the information you are seeking. Decide whether you wish to submit an informal request for the information or a formal request under the Access to Information Act. If you wish to make an informal request, contact the appropriate institution. The address can likely be found in Info Source publications which are available across Canada, generally in major public and academic libraries,
constituency offices of federal Members of Parliament and most federal government public enquiry and service offices.
Step 2
To apply for information under the Access to Information Act, complete this form or a written request mentioning the Act. Describe the information being sought and provide any relevant details necessary to help the institution find it. If you require assistance, refer to Info Source (Sources of Federal Government Information) for a description of program records held by the institution or contact its Access to Information Coordinator.
Step 3
Forward the access request to the Coordinator of the institution holding the information. The address is listed in the “Introduction” to Info Source. Enclose a $5.00 money-order or cheque payable to the Receiver General of Canada. Depending upon the type or amount of information being sought, you may be asked to authorize further charges.
Step 4
When you receive an answer to your request, review the information to determine whether you wish to make a further request under the Act. You also have the right to complain to the Access to Information Commissioner should you believe that you have been denied any of your rights under the Act.
Federal Government Institution
Provide details regarding the information being sought
Method of access preferred Receive copies
of originals
Examine originals in government offices Name of applicant
Street, address, apartment City or town
Province Postal Code Telephone number
This request for access to information under the
Access to Information Act is being made by
a Canadian citizen, permanent resident or
another individual present in Canada, or a corporation present in Canada
Signature Date
The personal information provided on this form is protected under the provisions of the Access to Information Act and the Privacy Act.
TBC 350-57 (Rev. 2000/06/19)
National Defence and the Canadian Armed Forces
I am seeking records that mention fires or other incidents such as gas poisoning related to the tents used by Canadian Forces, as well as the lamps and stoves used in the tents. I am seeking materials, dated between June 1, 2013 and January 31, 2014 that pertain to this topic, including but not limited to incident reports, memos, reccomendations, reports and briefing notes. Please only include email correspondence if it specically deals with the subject of fires or gas poisoning in relation to tents and the lamps and stoves used in the tents.
I am not interested in anything that is obviously a cabinet confidence. I don't want anything that requires third-party consultation. Cut out anything that is a public record.
As this request is in the public interest, I ask that all fees please be waived. Please contact me when any records are ready for release. ■
Paige Parsons
#3 130 MacLaren Street Ottawa
ACCESS TO INFORMATION AND PROTECTION OF PRIVACY
REQUEST FOR ACCESS TO RECORDS
ACCÈS À L’INFORMATION ET PROTECTION DES RENSEIGNEMENTS PERSONNELS
DEMANDE DE COMMUNICATION DE DOCUMENTS
Preferred method(s) of access to records Examine original Receive copy
Méthode de consultation préférée Consultation de l’original Obtention d’une copie de l’original APPLICANT
REQUÉRANT/REQUÉRANTE Name (last, first, middle)
Nom (nom de famille, prénom usuel, autres prénoms) _____________________________________________ Company / Organization (if applicable)
Entreprise / organisme (s’il y a lieu) _________________________________________________________________________________________________________ Mailing address
Adresse postale _________________________________________________________________________________________________________________________
City or town Territory/province/country Postal code
Ville/village __________________________________________ Territoire/province, pays __________________________ Code postal ______________________
Telephone (day) (alternate) Fax
Téléphone (jour) ______________________________________ (autre) ________________________________________ Télécopieur ______________________ REQUESTED INFORMATION
RENSEIGNEMENTS DEMANDÉSRENSEIGNEMENTS DEMANDÉSRENSEIGNEMENTS DEMANDÉS Name of public body (department, corporation or agency) Please complete a separate form for each public body
Nom de l’organisme public (ministère, société ou organisme) Prière de remplir un formulaire séparé pour chaque organisme public
Information requested Please list dates, events, agencies involved, file numbers, and any other details which will help the Public Body locate the records. If you are requesting another person’s information, you must attach either that person’s signed consent for disclosure or proof of authority to act on that person’s behalf. If you need more space, please attach a separate sheet of paper.
Renseignements demandés Énumérez les dates, les faits, les organismes en cause, les numéros de dossier et tout autre détail qui pourrait aider l’organisme public à
repérer les dossiers. Si vous voulez avoir accès à des renseignements concernant une autre personne, vous devez joindre soit le consentement à la divulgation de l’information signé par la personne en question, soit la preuve que vous avez le pouvoir d’agir au nom de cette personne. Si l’espace ci-dessous est insuffisant, veuillez joindre une feuille séparée.
Date received Records Manager
Demande reçue le ____________________________________________ Gérant des documents _________________________________________________
FOR ATIPP OFFICE USE ONLY
RÉSERVÉ AU BUREAU DE L’ACCÈS À L’INFORMATION ET DE LA PROTECTION DES RENSEIGNEMENTS PERSONNELS
Request no.
N° de demande A-________
YG(4552Q)F1 Rev.03/2003
Your signature Date signed
Votre signature X ________________________________________________________ Date de la signature ___________________________________________
Year • Année Month • Mois Day • Jour
Ms. Mrs. Miss Mr. Other Mme M. Autre ________
Prière d’envoyer le formulaire dûment rempli à l’adresse suivante :
Bureau de l’accès à l’information et de la protection des renseignements personnels (W-10) Ministère de la Voirie et des Travaux publics
Gouvernement du Yukon
C.P. 2703, Whitehorse (Yukon) Y1A 2C6
Les renseignements personnels contenus dans ce document sont recueillis en vertu de la Loi sur l’accès à l’information et la protection des renseignements personnels et seront utilisés uniquement afin de répondre à votre requête. Pour plus de renseignements, veuillez communiquer avec le coordonnateur de la Loi, Bureau de l’accès à l’information et de la protection des renseignements personnels, Ministère de la Voirie et des Travaux publics, C.P. 2703, Whitehorse (Yukon) Y1A 2C6; tél. : (867) 393-7048, ou sans frais au Yukon au 1-800-661-0408 poste 7048.
Please send completed form to:
ATIPP Office (W-10)
Department of Highways and Public Works, Government of Yukon Box 2703
Whitehorse, Yukon Y1A 2C6
Personal information contained on this form is collected under the Access to Information and Protection of Privacy Act and will be used only for the purpose of responding to your request. For further information, contact ATIPP Act Coordinator, ATIPP Office,Department of Highways and Public Works at Box 2703, Whitehorse, Yukon Y1A 2C6 or 867-393-7048, toll free within Yukon 1-800-661-0408 local 7048.
Time limit for response to Applicant:
Délai de réponse au requérant/à la requérante ________________________________________________________________________________________________________________________________________
Confidential • Confidentiel
Voirie et Travaux publics
Highways and Public Works
