PRIVACY ACT AGREEMENTPrivacy Act Agreement for Request of Motor Vehicle Records • September 10th, 2010
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 ofthis Agreement.An Iowa Department of Transportation employee will contact Requestor to advise whether the request is approved or denied. OFFICIAL USE ONLY Date Received: / / Authorized Access For: Required: Allowed: Personal Information:Highly Restricted Personal Information: Authorized By:
PRIVACY ACT AGREEMENTPrivacy Act Agreement for Request of Motor Vehicle Records • 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
