Request Servicing Center (RSC)
301 O'Malley Avenue Suite 37
Schriever Space Force Base, CO 80912-3037
Phone: (719) 567-6001
21st Communication Squadron/SCXKF
175 E Stewart Ave
Peterson Space Force Base, CO 80914
Phone: (719) 556-2197
The Freedom of Information Act, DODM 5400.7 AFMAN33-302, allows the general public including foreign citizens, military and civilian personnel acting as private citizens, to request records electronically or in writing from the Federal Government.
Some records are released to the public under the Freedom of Information Act, and may therefore reflect deletion of some information in accordance with the FOIA's nine statutory exemptions or two law enforcement record exclusions.
Send a written request to either the Schriever SFB or Peterson SFB FOIA offices. Identify where the record is located, describe the records you want as specifically as possible, and state that you agree to pay any associated fees.
Specify the information you want from the requested documents as possible, (e.g. the time, place, persons, events, subjects, or other details). It is recommended that requests contain a statement of accepting clearly releasable records as in accordance with the nine statutory exemptions.
Hard copy/paper request must have a postal mailing information with a personal contact and email address information included so the FOIA office can contact you.
To submit an electronic FOIA request click here.
A Privacy Act request allows individuals to gain access to their own personal records (unless the requested records are exempted from disclosure), and to seek correction or amendment of federally maintained records that are inaccurate, incomplete, untimely.
A PA request is one in which a United States citizen or Legal Permanent Resident seeks records on herself/himself that are contained in a file retrievable by the individual's name or personal identifier. A PA request must be submitted in writing via postal mail or fax.
Send a written request to either the Schriever SFB or Peterson SFB FOIA offices.
The request must include valid form of identification such as a copy of a photo ID or driver's license. It must include your full name and current address so we may mail your response.
Make sure to describe the record you are seeking in detail. Details may include information about the document; the specific System of Records Notice (SORN), including the System ID and System Name, where the records can be found; and the time frame to be searched.
As a resource, utilize the DPCLTD SORN page. Each SORN has a specific Record Access Procedure category; please include the detailed information from that section in your request.
Keep in mind that only the individual to whom the record pertains can request the records and be sure to sign your request. Your signature must be notarized or submitted via an unsworn declaration in accordance with 28 U.S.C. 1746, a law that permits statements to be made under penalty of perjury as a substitute for notarization.
If you are executing the unsworn declaration within the United States, its territories, possessions, or commonwealths, it must read as follows: "I declare (or certify, verify, or state) under penalty of perjury that the foregoing is true and correct. Executed on (date). (Signature)."
For unsworn declarations outside the United States, it must read as follows: "I declare (or certify, verify, or state) under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. Executed on (date). (Signature)."
First or Third Party requesters must meet the requirements as outlined under the provisions of Health Insurance Portability and Accountability Act (HIPPA) and comply with the regulation of HIPPA guidelines and procedures as required by DOD 6025.18-R, DOD Health Information Privacy Regulation; and DOD 8580.02-R, DOD Health Information Security Regulation.
The following documents/forms/authorization/sworn notarized statement must be included with the medical records request as follows:
1) A signed DD Form 2870, Authorization for Disclosure of Medical or Dental Information
2) Provide a copy of a verification of Identity (i.e. driver’s license, state ID) that includes a sworn/notarized "I declare under penalty of perjury under the laws of the United States of America that the foregoing information (concerning my identity) is true and correct. Executed on (date)(signature)."
3) If you're representing as Third Party, a sworn/Notarized Authorizations/Power of Attorney statement must be signed from the individual authorizing the disclosure/release of the documents be included in the request.
For the 21st Medical Group Outpatient Records and Release of Information click here.
Fees are charged based on the requestor's category:
1. Commercial (pay search, review, and reproduction fees);
2. Non-commercial scientific or educational institutions or news media (pay reproduction fees; first 100 pages provided at no cost)
3. Others (pay search and reproduction fees; first two hours search and 100 pages provided at no cost
If dissatisfied RSC service contact:
Ms. Anh Trinh
AF FOIA Public Liaison Officer
1800 Air Force Pentagon
Washington, DC 20330-1800
(Do not send FOIA requests here)
Headquarters Air Force/AAII (FOIA)
1000 Air Force Pentagon
Washington, DC 20330-1000
(703) 693-2735 / 692-9981
Air Force FOIA
DoD FOIA Handbook
Electronic FOIA Library
Section 508 Compliance
Air Force Privacy Act
21st Medical Group Records
System of Record Notices