"Request to Correct Personal Information Form" - New Brunswick, Canada

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Request to Correct Personal Information Form
Instructions
The
Right to Information and Protection of Privacy Act (RTIPPA)
provides a method to request correction of
personal information held by public bodies that is not available by other means. A request to correct personal
information is a written request to correct records of a personal nature about you when you think there has been an
error or omission.
Many public bodies already have procedures in place to correct personal information. You can, therefore, often
have your information corrected without making a formal request under RTIPPA. Before making a formal request,
contact the Coordinator of the public body you believe has the information you want to correct. The Coordinator
can help you determine if a formal request is needed. The Coordinator can also help you complete the request to
correct personal information form, if needed. For contact information for Coordinators see the
Directory of Public
Bodies.
A
BOUT YOU
In this section of the form, please include:
your last name, first name and preferred title, if any; the name of the company or organization you are
representing, if applicable;
your complete mailing address and daytime telephone numbers so that the public body can contact you
about the request; and
a fax number or e-mail address, if any, where correspondence may be sent.
A
BOUT YOUR REQUEST
Please check which person’s information you would like to correct.
If you are requesting a correction to another person’s information, please attach proof that you can legally
act for that person. This authorization can be in the form of a signed letter in which the person provides
consent to you to correct his or her information, a Power of Attorney, or other legislated authorization.
Please see section 79 of
RTIPPA
for more details.
State the name of the public body to which you are making the request. All public bodies are listed in the
Directory of Public
Bodies.
A
BOUT THE INFORMATION YOU WANT TO CORRECT
Clearly describe in detail the information you want corrected and why. Also, describe how you want the
information to be corrected and on what records the information appears.
Be as specific as possible in describing the records containing the information you want corrected (i.e. time,
place and event). Feel free to add any additional information you think may help with processing your
request. For example, provide any other names you currently or previously used and any identifying
number that relates to the records in question (e.g. case file number). If you need more space than
provided, continue your description on a separate sheet of paper and attach it to the request form.
Documents supporting your request to correct personal information should be attached to the form. For
example, if you are requesting a change to your name attach proof of your name change.
F
There are no fees when making a request to correct personal information.
EES
A
BOUT YOUR PERSONAL INFORMATION
Personal information provided on this form is collected under paragraph 37(2)(a) of
RTIPPA
for
purposes of responding to your request to correct personal information. Should you require further
information about collection, use and disclosure of personal information, please contact the Information
Access and Privacy Unit at (506) 444-4180.
W
HERE TO SEND YOUR REQUEST
Be sure to sign, date and send your request to the Coordinator of the public body to which you are making
the request. Coordinators and their contact information are listed in the
Directory of Public Bodies
on the
RTIPPA
website.
If you are unsure of where to send your request for information, please contact the Information Access and
Privacy Unit at (506) 444-4180.
Reset
Request to Correct Personal Information Form
Instructions
The
Right to Information and Protection of Privacy Act (RTIPPA)
provides a method to request correction of
personal information held by public bodies that is not available by other means. A request to correct personal
information is a written request to correct records of a personal nature about you when you think there has been an
error or omission.
Many public bodies already have procedures in place to correct personal information. You can, therefore, often
have your information corrected without making a formal request under RTIPPA. Before making a formal request,
contact the Coordinator of the public body you believe has the information you want to correct. The Coordinator
can help you determine if a formal request is needed. The Coordinator can also help you complete the request to
correct personal information form, if needed. For contact information for Coordinators see the
Directory of Public
Bodies.
A
BOUT YOU
In this section of the form, please include:
your last name, first name and preferred title, if any; the name of the company or organization you are
representing, if applicable;
your complete mailing address and daytime telephone numbers so that the public body can contact you
about the request; and
a fax number or e-mail address, if any, where correspondence may be sent.
A
BOUT YOUR REQUEST
Please check which person’s information you would like to correct.
If you are requesting a correction to another person’s information, please attach proof that you can legally
act for that person. This authorization can be in the form of a signed letter in which the person provides
consent to you to correct his or her information, a Power of Attorney, or other legislated authorization.
Please see section 79 of
RTIPPA
for more details.
State the name of the public body to which you are making the request. All public bodies are listed in the
Directory of Public
Bodies.
A
BOUT THE INFORMATION YOU WANT TO CORRECT
Clearly describe in detail the information you want corrected and why. Also, describe how you want the
information to be corrected and on what records the information appears.
Be as specific as possible in describing the records containing the information you want corrected (i.e. time,
place and event). Feel free to add any additional information you think may help with processing your
request. For example, provide any other names you currently or previously used and any identifying
number that relates to the records in question (e.g. case file number). If you need more space than
provided, continue your description on a separate sheet of paper and attach it to the request form.
Documents supporting your request to correct personal information should be attached to the form. For
example, if you are requesting a change to your name attach proof of your name change.
F
There are no fees when making a request to correct personal information.
EES
A
BOUT YOUR PERSONAL INFORMATION
Personal information provided on this form is collected under paragraph 37(2)(a) of
RTIPPA
for
purposes of responding to your request to correct personal information. Should you require further
information about collection, use and disclosure of personal information, please contact the Information
Access and Privacy Unit at (506) 444-4180.
W
HERE TO SEND YOUR REQUEST
Be sure to sign, date and send your request to the Coordinator of the public body to which you are making
the request. Coordinators and their contact information are listed in the
Directory of Public Bodies
on the
RTIPPA
website.
If you are unsure of where to send your request for information, please contact the Information Access and
Privacy Unit at (506) 444-4180.
Request to Correct Personal Information Form
A
:
BOUT YOU
Title
Last name
First name
Name of company or organization (where applicable)
Mailing Address
City or Town
Province
Postal Code
Home Telephone #
Work Telephone #
Facsimile #
E-mail
Personal information provided on this form is collected under paragraph 37(2)(a) of New Brunswick’s
Right
to Information and Protection of Privacy Act (RTIPPA)
for purposes of responding to your request to correct
personal information. Should you require further information about collection, use and disclosure of personal
information, please contact the Information Access and Privacy Unit at (506) 444-4180.
A
:
BOUT YOUR REQUEST
1. Whose personal information do you want to correct? Please check one.
Your own personal information
Another person’s information (Please attach proof that you can legally act for that person. This
authorization can be in the form of a signed letter, a Power of Attorney, or other legislated
authorization. Please see section 79 of
RTIPPA
for more details.)
2. To which public body are you making your request? (Please fill in below the name of the public body. For
names of public bodies consult the
Directory of Public Bodies
on the
RTIPPA
website.)
A
:
BOUT THE INFORMATION YOU WANT TO CORRECT
1. What personal information do you want to be corrected? (Please provide as much detail as possible. Be
sure to give the complete name that is in the records and any identifying number related to the records in
question).
Request to Correct Personal Information Form
2. What correction(s) do you want to make and why? (Please attach any documents that support your
request).
Y
:
OUR SIGNATURE
Signature:
Date:
W
:
HERE TO SEND YOUR REQUEST
Send your request to the Coordinator of the public body you believe has the information you want corrected.
If you are unsure of where to send your request to correct personal information, please contact the
Information Access and Privacy Unit at (506) 444-4180.
FOR PUBLIC BODY USE ONLY:
Date Received
Comments
Request Identification Number
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