PUBLIC INFORMATION REQUEST (PIR) FORM

The following form must be completed and submitted to the Puerto Rico Department of Housing (PRDOH) for any public information request(s) from the Community Development Block Grant- Disaster Recovery Program (CDBG-DR Program). Please note that, should the request be unclear or excessive in amount of information, you may be contacted to further narrow down the request. For additional information on this process, please refer to the Record Keeping, Management, and Accessibility Policy (RKMA Policy) at https://www.cdbg-dr.pr.gov/en/download/record-keeping-management-and-accessibility-policy-rkma-policy/.

Petitioner’s Personal Information

First Name

Last Names

Is the Petitioner representing a legal entity?

Yes

Contact Information

Physical Address

Postal Address

Postal address is the same as physical address

Email Address

Preferred method of communication

Telephone Number

Public Information Requested

PRDOH CDBG-DR Division or area custodian of the information (if known).

Provide a detailed description of the information requested.

Does this information involve a third party?

Yes

Preferred format of the information requested.

*May entail corresponding fees for the reproduction costs incurred by PRDOH.

Electronic Copy

Hard Copy*

I have completed all the information required by this form and include, if any, attached authorization certification. By signing this form, I certify that the information here provided is correct and corresponds to the best of my knowledge. I agree to comply with any applicable fees my information request may entail.

Date

Signature

Send me a copy of my responses

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