Form 440-4871 "Public Records Request" - Oregon

What Is Form 440-4871?

This is a legal form that was released by the Oregon Department of Consumer and Business Services - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2014;
  • The latest edition provided by the Oregon Department of Consumer and Business Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 440-4871 by clicking the link below or browse more documents and templates provided by the Oregon Department of Consumer and Business Services.

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Download Form 440-4871 "Public Records Request" - Oregon

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Oregon Department of Consumer and Business Services
Division of Financial Regulation
350 Winter St. NE, Room 410, Salem, Oregon 97301-3881
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140  Fax: 503-947-7862
http://dfcs.oregon.gov
PUBLIC RECORDS REQUEST
INSTRUCTIONS
To review or obtain copies of public records, complete the “Requestor Information” section of this form and return it to
the division. Division staff will respond, acknowledging receipt of the request, and provide information about the status of
the request and any fees associated with the request. Records will be sent after payment is received.
Requests to inspect records must be made at least 10 working days in advance of the inspection.
REQUESTOR INFORMATION
Name:
Organization:
Address (Street or P.O. Box):
City:
State:
ZIP:
Phone:
Fax:
Email:
Specific documents to be examined or copied
:
(please include file number, if known)
Date to inspect records
:
-
-
(if applicable)
Need for the requested records:
FEES (OAR 440-005-0030) See Page 2 for fee schedule.
Unless waived, fees must be paid before records are released.
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440-4871 (09/14/COM)
Oregon Department of Consumer and Business Services
Division of Financial Regulation
350 Winter St. NE, Room 410, Salem, Oregon 97301-3881
Mailing address: P.O. Box 14480, Salem, OR 97309-0405
503-378-4140  Fax: 503-947-7862
http://dfcs.oregon.gov
PUBLIC RECORDS REQUEST
INSTRUCTIONS
To review or obtain copies of public records, complete the “Requestor Information” section of this form and return it to
the division. Division staff will respond, acknowledging receipt of the request, and provide information about the status of
the request and any fees associated with the request. Records will be sent after payment is received.
Requests to inspect records must be made at least 10 working days in advance of the inspection.
REQUESTOR INFORMATION
Name:
Organization:
Address (Street or P.O. Box):
City:
State:
ZIP:
Phone:
Fax:
Email:
Specific documents to be examined or copied
:
(please include file number, if known)
Date to inspect records
:
-
-
(if applicable)
Need for the requested records:
FEES (OAR 440-005-0030) See Page 2 for fee schedule.
Unless waived, fees must be paid before records are released.
Page 1
440-4871 (09/14/COM)
Note: Total cost may vary according to specific request. Higher fees may apply to information or research provided by the
Information Technology and Research Section.
1.
Staff time required to locate, produce, summarize, or otherwise provide records (this does not include making copies;
labor is included in the fee for copying):
A.
Secretarial/clerical, $25 per hour.
B.
Professional/technical, $45 per hour.
C.
Information Technology and Research Section research analyst, $63 per hour.
D.
Information Technology and Research Section, IT-Application Development and Computer Support Services, $70
per hour.
E.
Actual attorney fees charged to the department for the cost of time spent by an attorney in reviewing the request
and the actual records, redacting material from the public records, or segregating the public records into exempt
and nonexempt records.
There is no charge for less than a half-hour of DCBS staff time. This minimum can apply only to one request per
requestor per month.
2.
Photocopies/microfilm, 25 cents per page (this includes labor). There is no charge for fewer than 40 pages. This
minimum can apply only to one request per requestor per month. The only exception is the Insurance Division’s
public copier. Members of the public may use this copier and pay five cents per page, and the minimum number of
pages does not apply.
3.
Copies of existing mailing lists with labels, $5 per 100 names, with no additional charge for staff time.
4.
For computerized records include the following costs: $.005 (½ cent) per record of output; plus professional staff time
(cost above) to write program; plus charges for physical storage media, such as diskette, CD, or thumb drive.
5. Laser photos, $1 per page plus staff time.
6. Video tape, $12.50; audio tape, $5 (includes staff time), CD, $6.
7. Certified document, $10 (includes staff time).
8. Other items that can be included in the cost of a copy:
• Shipping charges (including postage).
• Cost of fax transmission if long distance.
• Printing costs.
• Actual cost of any other supplies or services necessary to furnish the material.
• Department of Administrative Services (DAS) or other external processing charges, actual charges for the job.
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