UIPA Forms

Forms for the Public:

Public Form in PDF Format	Public Form in Word Format	Notes
Request to Access Government Record (PDF)	Request to Access Government Record (Word)	The public may use the Request to Access Government Records form to ask a Hawai‘i State or county agency for a record. Click on the highlight/form field above a line to enter information Send the completed form directly to the government agency that holds or administratively controls the record you seek. For more information, see How to Request a Record. OIP does not maintain other agencies’ records or respond to requests on their behalf. Do not send this form to OIP unless you’re requesting records maintained by OIP.
Request for Assistance to the Office of Information Practices (PDF)	Request for Assistance to the Office of Information Practices (Word)	The public may use this form to request OIP’s assistance if a government agency has not responded to your record request within 10 business days or has given you an incomplete response. Click on the highlight/form field above a line to enter information

Agency Form in PDF Format	Agency Form in Word Format	Notes
Notice to Requester (PDF)	Notice to Requester (Word)	Agencies may use the Notice to Requester (NTR) when replying to a record request. The NTR must be provided to the requester within 10 business days of the request. Click on the highlight/form field above a line to enter information
Acknowledgment to Requester (PDF)	Acknowledgment to Requester (Word)	Agencies may use the acknowledgment form only when an agency cannot complete the NTR within the initial ten-business-day deadline due to extenuating circumstances and needs up to an additional ten business days (a total of 20 business days from the date the request was received). An NTR must still be sent by the end of the extended response period. Click on the highlight/form field above a line to enter information