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