Contact Information 

* First Name 

MI 

* Last Name 

* Address Line 1 

Address Line 2 

* City 

* State 

* Zip 

* Email 

Work Phone 


Freedom of Information 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: 


Description 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 private entity from knowingly obtaining or using any personal information obtained from our agency for commercial solicitation 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 commercial solicitation in violation of the law.


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

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