Access/Correction Request
Freedom of Information and Protection
of Privacy
Request for:
Access to General Records
Access to Own Personal Information
Correction of Own Personal Information
Institution request made to:
County of Dufferin
55 Zina Street
Orangeville, Ontario L9W 1E5
If request for access to, or correction of own personal information records:
Last name appearing on records:
same as below
or ĺ
Details:
First name:Last name:
Middle name:
Mr. Mrs. Ms. Miss
Address:
City:
Province:
Postal Code:
Day phone:
Evening phone:
Detailed description of requested records, personal information records, or personal
information to be corrected. (If you are requesting access to, or correction of, your personal
information, please identify the personal information bank or record containing the personal
information, if known).
Note: If you are requesting a correction of personal information, please indicate the
desired correction and, if appropriate, attach any supporting documentation. You will be
notified if the correction is not made and you may require that a statement of
disagreement be attached to your personal information.
Preferred method of access to records:
Examine Original Receive Copy
Signature:
Date:
Municipal Freedom of Information and Protection of Privacy Act
SCHEDULE OF FEES
Municipal Freedom of Informa
tion and Protection of Privacy Act R.S.O. 1990, c.M.56 as
amended and Regulation 823 as amended to O.Reg 480/97
stipulates the following fee schedule:
Fees
Application Fee .................................................. $ 5.00
(payable at time of submission of applic
ation)
Photocopies
and Computer printouts ................. $ 0.20 per page
Floppy Disks ...................................................... $ 10.00 per disk
Manually searching a record ............................... $ 7.
50
(for each 15 minutes spent b
y any person)
Preparation of Record for disclosure ................... $ 7.50
(for each 15 minutes spent b
y any person including severing a part of the record)
Developing a computer program or other
method of producing a record from machine
readable record ................................................. $ 15.00
(for each 15 minutes spen
t by any person)
The costs, including computer costs, that the institution incurs in locating, retrieving processing
and copying the record if those costs are specified in an invoice that the institution has received
If an estimate of an amount payable under the Act is $100.00 or more, the County of Dufferin may
require a deposit of 50% of the estimate before taking any further steps to respond to the request.
Appealing a Decision
Appeal of
access to general information ........... $ 25.00
Appeal of
access to personal information ......... $ 10.00
Request for correction of personal information . $ 10.00
For Institution Use Only:
Request Number:Date Received:
Comments:
Personal information contained on this f
orm is collected pursuant to Freedom of Information
and Protection of Privacy Legislation and will be used for the purpose of responding to your
request. Questions about this collection should be directed to the Freedom of Information and
Privacy Coordinator at the institution where the request is made.
Review of Fees
(initial)
Print Form