Social Welfare Services
Application form for FOI 2
Request for Amendment of
Data Classification R
Personal Records
• Please answer all questions.
• Please use BLOCK LETTERS and place an X in the relevant boxes.
• For more information, log on to www.gov.ie.
• If the space provided is not enough, please attach a separate sheet of paper.
• You should attach any documents which would support your claim and let us know
which documents should be returned to you.
Part 1 Your own details
1. Your PPS No.:
2. Title: (insert an ‘X’ or Mr. Mrs. Ms. Other
specify)
3. Surname:
4. First name(s):
Contact Details
6. Your address:
County Postcode
7. Your telephone number: MOBILE
LANDLINE
8. If you are making this request on behalf of an organisation or company please state:
Name of organisation
or company:
Position you hold within the organisation or company:
Part 2 Details of request
9. In accordance with Section 9 of the Freedom of Information Act 2014, I seek amendment of
personal records.
I claim that the records described below to which you provided me access under the Freedom of
Information Act contain information relating to my personal affairs that is:
Incomplete Incorrect Misleading
10.The record(s) containing the information is/are:
Please describe the records you wish to be amended as clearly as you can.
11.The information that needs to be changed is:
Please describe the information you wish to have changed as clearly as you can.
12.The information which I want to appear on the record(s) identified above is as follows:
Part 2 continued Details of request
13.The reason(s) why I claim the information is incomplete, incorrect or misleading is/are:
Please include appropriate information in support of your application. It is not enough to merely
state that the record in question is incomplete, incorrect or misleading. You will need to provide
documentary evidence to back up your claim, for example, if factual information such as birth date
is claimed to be incorrect, then evidence of the correct date must be provided.
Date:
D D M M Y Y Y Y
Signature (not block letters)
For official use only
ID Checked
To request the amendment of personal records send this completed
application form to:
The FOI Unit Please note that the Department of Social
Department of Social Protection Protection cannot guarantee that any
Shannon Lodge personal and sensitive data, sent by email,
Carrick on Shannon is fully secure. Customers who choose
Co Leitrim to use this channel are deemed to have
N41 KD81 accepted any risk involved.
Email: foi@welfare.ie
For more information log on to www.gov.ie.
Data Protection Statement
The Department of Social Protection administers Ireland’s social protection system. Customers are
required to provide personal data to determine eligibility for relevant payments and benefits. Personal
data may be exchanged with other government departments and agencies where provided for by law.
Our data protection policy is available at www.gov.ie/dsp/privacystatement or in hard copy.
Explanations and terms used in this form are intended as a guide only and are not a legal interpretation.
00K 11-20 Edition: November 2020
