Agency OPRA Request Performance Form
Requestor Name
City/Zip
Phone
Email
Agency to which the request was made
Agency staff member/records custodian handling the request
How request was submitted (email, letter, government form)
Date request was submitted
MM
/
DD
/
YYYY
Specific documents requested
Description of initial agency response
Date of initial agency response
MM
/
DD
/
YYYY
Date of any follow up responses
MM
/
DD
/
YYYY
Nature/content of follow up responses
Costs charged for document copying or retrieval
Costs charged for document copying or retrieval
Were you notified in advance of the costs?
Clear selection
Did you receive the documents?
Clear selection
Was there any delay on that agency's part that could have been avoided?
Clear selection
Was there any delay on that agency's part that could have been avoided?
Clear selection
If yes, please explain.
How would you rate the agency's overall response? (1-5 scale, with 1 "unhelpful" and 5 "helpful")
Clear selection
Any other comments?
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