NOTE: In most cases, a completed RTKL request form is a public record. Form updated Feb. 3, 2020
More information about the RTKL is available at https://www.openrecords.pa.gov
Standard Right-to-Know Law Request Form
Good communication is vital in the RTKL process. Complete this form thoroughly and retain a copy; it may be
required if an appeal is filed. You have 15 business days to appeal after a request is denied or deemed denied.
SUBMITTED TO AGENCY NAME: _____________________________________________________________________(Attn: AORO)
Date of Request: __________________________________ Submitted via: Email U.S. Mail Fax In Person
PERSON MAKING REQUEST:
Name: ________________________________________________ Company (if applicable): ______________________________________
Mailing Address: ________________________________________________________________________________________________________
City: ____________________________ State: ________ Zip: ______________ Email: ____________________________________________
Telephone: ____________________________________________________ Fax: ____________________________________________________
How do you prefer to be contacted if the agency has questions? Telephone Email U.S. Mail
RECORDS REQUESTED: Be clear and concise. Provide as much specific detail as possible, ideally including subject
matter, time frame, and type of record or party names. RTKL requests should seek records, not ask questions. Requesters
are not required to explain why the records are sought or the intended use of the records unless otherwise required by law.
Use additional pages if necessary.
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DO YOU WANT COPIES? Yes, printed copies (default if none are checked)
Yes, electronic copies preferred if available
No, in-person inspection of records preferred (may request copies later)
Do you want certified copies? Yes (may be subject to additional costs) No
RTKL requests may require payment or prepayment of fees. See the Official RTKL Fee Schedule for more details.
Please notify me if fees associated with this request will be more than $100 (or) $____________.
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ITEMS BELOW THIS LINE FOR AGENCY USE ONLY
Tracking: ____________________ Date Received: ____________________ Response Due (5 bus. days): ____________________
30-Day Ext.? Yes No (If Yes, Final Due Date: ___________________) Actual Response Date: ____________________
Request was: Granted Partially Granted & Denied Denied Cost to Requester: $_____________________
Appropriate third parties notified and given an opportunity to object to the release of requested records.