This form contains 39 fields organized into 12 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Agency Use Only - 30-Day Extension
30-Day Extension - Yes	Radiobutton	Check this box when the agency is claiming a 30-day extension to respond to the request and will provide a final due date.
30-Day Extension — Final Due Date	Date	Enter the final response due date assigned when a 30-day extension is granted for this request. Fill only if '30-Day Extension - Yes' is 'Yes'. Depends on: 30-Day Extension - Yes
30-Day Extension - No	Radiobutton	Check this box when the agency is not claiming a 30-day extension and will respond within the original statutory time frame.
Agency Use Only - Actual Response Date
Actual Response Date (Agency Use Only)	Date	Enter the date the agency actually responded to the request; this is the official response date recorded by the agency.
Agency Use Only - Request Disposition and Cost
Granted	Radiobutton	Check this box when the agency has fully granted the right-to-know request and provided the requested records.
Cost to Requester	Number	Enter the total amount charged to the requester for this records request as assessed by the agency.
Partially Granted & Denied	Radiobutton	Check this box when the agency has provided some of the requested records but denied other portions of the request.
Denied	Radiobutton	Check this box when the agency has denied the request in its entirety and no records are being released.
Agency Use Only - Third Party Notification
Appropriate third parties notified and given an opportunity to object to the release of requested records	Checkbox	Check this box when the agency has notified all applicable third parties and afforded them an opportunity to object to releasing the requested records before release.
Agency Use Only - Tracking and Due Dates
Tracking Number	Text	Enter the agency's internal tracking or reference identifier assigned to this request.
Date Received	Date	Enter the date the agency received the request.
Response Due Date (5 business days)	Date	Enter the date by which the agency's response is due under the five-business-day timeframe.
Certified Copies Request
Certified copies — Yes (may be subject to additional costs)	Radiobutton	Check this box if you want certified copies of the requested records and accept that certified copies may incur additional costs.
Certified copies — No	Radiobutton	Check this box if you do not want certified copies of the requested records.
Copies Format Preference
Yes, printed copies (default if none are checked)	Radiobutton	Check this box when you want paper/printed copies of the records (this is the default if you do not select any option).
Yes, electronic copies preferred if available	Radiobutton	Check this box when you prefer to receive records in electronic format (e.g., PDF) if the agency can provide them.
No, in-person inspection of records preferred (may request copies later)	Radiobutton	Check this box when you prefer to inspect the records in person rather than receive copies, understanding you may request copies later.
Fee Notification Threshold
Notify if fees will be more than $100	Radiobutton	Check this box if you want the agency to notify you when the fees for this request are expected to exceed $100.
Fee notification threshold	Number	Enter the dollar amount at which you want the agency to notify you if estimated fees for this request will exceed that amount. Fill only if 'Notify if fees will be more than the specified amount' is 'Yes'. Depends on: Notify if fees will be more than the specified amount
Notify if fees will be more than the specified amount	Radiobutton	Check this box if you want the agency to notify you when the fees for this request are expected to exceed the custom dollar amount you enter in the adjacent blank.
Preferred Method of Contact
Telephone	Radiobutton	Check this box if you prefer the agency contact you by telephone when they have questions about your request.
Email	Radiobutton	Check this box if you prefer the agency contact you by email when they have questions about your request.
U.S. Mail	Radiobutton	Check this box if you prefer the agency contact you by postal mail when they have questions about your request.
Records Requested Description
Records Requested Description	Text	Enter a clear, concise description of the records you are requesting, including specific subject matter, time frame, types of records, and any party names or other details needed to identify the records.
Requester Identification and Contact Information
Requester Name	Text	Enter the full name of the person submitting this Right-to-Know request.
Requester Company (if applicable)	Text	Provide the name of the company or organization you represent, or leave blank if not applicable.
Requester Mailing Address	Text	Enter the street address or P.O. box for mailing correspondence related to this request.
Requester City	Text	Enter the city for the mailing address provided above.
Requester State	Text	Enter the state for the mailing address (e.g., PA or Pennsylvania).
Requester ZIP Code	Text	Enter the postal ZIP code for the mailing address.
Requester Email Address	Text	Provide a valid email address where the agency can contact you about this request.
Requester Telephone Number	Text	Enter a daytime telephone number, including area code, where you can be reached if the agency has questions.
Requester Fax Number	Text	Enter a fax number if you wish to receive communications by fax, or leave blank if not applicable.
Submitting Agency and Request Date/Method
Submitted To Agency Name	Text	Enter the full name of the agency to which you are submitting this Right-to-Know Law request.
Date of Request	Date	Enter the date on which this request was submitted to the agency.
Email	Radiobutton	Check this box if you are submitting the request by email.
U.S. Mail	Radiobutton	Check this box if you are submitting the request by U.S. Postal Service mail.
Fax	Radiobutton	Check this box if you are submitting the request by fax.
In Person	Radiobutton	Check this box if you are submitting the request in person (delivered directly to the agency).

Standard Right-to-Know Law Request Form Instructions