Contact Information 

* First Name 

MI 

* Last Name 

* Address Line 1 

Address Line 2 

* City 

* State 

* Zip 

* Email 

Work Phone 


Freedom of Infromation Request Form  
Customer Service: (803) 898-3882

Date 


Requested Information 


What is the period of time for the records/file review requested? 


Facility or project name: 


Facility address: 


County 


DHEC file custodian/staff contact if known: 


Descripiton of document or files requested: 


Please upload any relevant attachments that can assist with your FOI Request. 




Family Privacy Protection Act Statement

* The Family Privacy Protection Act, SC Code Section 30-2-50, prohibits any person or prviate entity from knowingly obtaining or using any personal information obtained from our agency for commercial solitication directed to any person in the State.  Violation of this law is a crime.  


I have read and understand this statement.  I am not requesting this information for the purposes of commericial solicitation in violation of the law.


Personal information provided in this document is subject to public scrutiny or release.

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