Department of Homeland Security PAL-Create Request

Department of Homeland Security PAL-Create Request Skip to the main content of the page

Please wait while validating Charge Number...

Submit Request

Contact Information

Prefix

First Name*
25 more characters

Middle Name
20 more characters

Last Name*
25 more characters

Suffix

Street1*
120 more characters

Street2
80 more characters

City*
25 more characters

State*

State (Other)
25 more characters

Zip Code
10 more characters

Country*

Phone
25 more characters

Email Address*
150 more characters

Organization
50 more characters

Confirm Email Address*
150 more characters

Job Title
100 more characters

Default Category*

General Information

DHS Component*

Selected Component

Please ensure Request Type matches up to the Component

Request Type*

Suggested Requester Category*

Delivery Mode*

Requesting Personal Records

** If you are requesting access to records about an individual, additional information may be required in order to facilitate the processing of your request. The DHS component your request is routed to will advise you if any additional information is required to aid the disclosure process.**

Are you requesting records on yourself?

Please Select:

* If yes, please read the Perjury Statement and Initial in the section below OR attach your Certification of Identity in the Request Information below.

I declare (or certify, verify, or state) under penalty of perjury under the laws of the United States of America that the foregoing is true and correct.
By initialing here you are providing your electronic signature.

Initial Here:
4 more characters

Request Information

* For Requests to OBIM for IDENT Records, please attach your Fingerprint Card Scans above in addition to filling out the Request Description below.

Request Description*

Date Range for Record Search:
From(mm/dd/yyyy)

To
(mm/dd/yyyy)

Fee Information

Willing Amount ($)
8 more characters

Fee Waiver Requested

* Fees otherwise chargeable in connection with a request for disclosure of a record shall be waived or reduced where it is determined that disclosure is in the public interest because it is likely to contribute significantly to public understanding of the operation or activities of the government and is not primarily in the commercial interest of the requester.

Fee Waiver Request Reason
255 more characters

Willing to Pay All Fees

Expedite Information

* Some requests may qualify for expedited treatment if the requester can demonstrate that it meets certain criteria established under DHS regulations. See 6 C.F.R. § 5.5(d)(1)

Expedite Requested

Expedite Reason
255 more characters

Security Information

Note:	Click on the Folder Name to View.
	Click the icon to download the Folder.