Case Number [REQUESTERPREFIX] [REQUESTERNAME] [COMPANY] [STREET1] [CITY], [STATESHORT] [ZIPCODE] Dear [REQUESTERPREFIX] [RLNAME]: This is our interim

response to your Freedom of Information Act (FOIA) request dated [REQUESTEDDATE], received in the office [RECEIVED]. You requested [REQUESTDESCRIPTION]. In accordance with DoD Directive 5400.7-R a notarized statement or a sworn identity declaration statement is needed in order to continue to process your request. Submit the below statement within 14 days of the date of this letter. If we do not receive this statement your request will be administratively closed. I declare under penalty of perjury that I am, in fact [insert your name and SSN] and that I currently reside at [insert complete mailing address] and that the documents requested in my FOIA/Privacy Act request of [insert date] filed with the Defense Threat Reduction Agency pertain to me. Executed on [date] [Signature] Should you need further assistance regarding this request, please contact the FOIA action officer, [OFFICERNAME], at [OFFICERPHONE] or the Requester Service Center at (703) 767-1792. Sincerely,

Juanita Y. Gaines Chief, Freedom of Information/ Privacy Act Branch