Common Contracts

PRIVACY ACT AGREEMENT

May 19th, 2009

• Filed
  May 19th, 2009

INSTRUCTIONS:● This Privacy Act Agreement for Request of Motor Vehicle Records must be completed and approved before a Requestor can obtain personal information or highly restricted personal information from the Iowa Department of Transportation. Only Requestors who meet the criteria outlined in Part C are eligible to obtain such information from the Iowa Department of Transportation. This Agreement must be completed with all required attachments before the Iowa Department of Transportation will consider a request for motor vehicle records.● Requestor must attach a legible photocopy of his or her driver’s license or non-driver identification card.● Requestor must print his or her full name on each page of this Agreement.● An Iowa Department of Transportation employee will contact Requestor to advise Requestor whether the request is approved or denied. OFFICIAL USE ONLY: Date Received: / / Authorized Access For: Required: Allowed:Personal Information:Highly Restricted Personal Informat