California Public Records Act /Freedom of Information Act Record Request Form
LAFPP_CPRA
Date
*
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Month
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Day
Year
Date
Request made by
*
First Name
Last Name
Company
Email
*
example@example.com
Reply to Email
Details of Request:
*
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Decision Deadline:
Days to Add
Assigned to section:
*
Please Select
Accounting
Active Member Services
Administrative Services
Communications & Education
DROP/Service Pensions
Disability Pensions
Executives
Human Resources
Internal Audit
Investments
Medical & Dental Benefits
Retirement Services
Systems
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Who is Working on This
*
Status
*
Date of Outreach
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Month
-
Day
Year
Decision Date
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Month
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Day
Year
Date
Decision
Yes
No
Tentative Date of Delivery
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Month
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Day
Year
Date
Response Prepared
Extension Deadline
Extension Required
Yes
No
Status Comments
Decision Extended Until (No extension shall be requested that goes 24 days beyond the initial date of request.)
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Month
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Day
Year
Date
Date of Delivery
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Month
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Day
Year
Date
Fulfilled Action:
Upload a PDF of the final email sent to the Requestor. The email should itemize the responsive files attached, but the files themselves should not be uploaded to this form.
Browse Files
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Choose a file
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Comments:
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Request Completed:
*
Completion Date
*
-
Month
-
Day
Year
Date
Submit
Which Section is Working on This
Please Select
Accounting
Active Member Services
Administrative Services
Communications & Education
DROP/Service Pensions
Disability Pensions
Executives
Human Resources
Internal Audit
Investments
Medical & Dental Benefits
Retirement Services
Systems
Response Status Date
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Month
-
Day
Year
Date
Response Options
Please Select
Review with City Attorney
Other
Response (example: Review with City Attorney)
Should be Empty: