NJDA Request Form - State of New Jersey

State of New Jersey
Department of Agriculture
GOVERNMENT RECORDS REQUEST FORM
Important Notice
The reverse side of this form contains important information related to your rights concerning government records. Please read it carefully.
In addition, please note that you may complete and submit requests electronically on the Internet at www.nj.gov/opra.
Requestor Information – Please Print
Payment Information
Maximum Authorization Cost $
First Name
Last Name
MI
Select Payment Method
Company
Cash
Mailing Address
City
State
Zip
Preferred Delivery:
Area Code
Pick Up
Money Order
Email
Fees:
Business Hours Telephone:
Check
Number
US Mail
Extension
On Site Inspect
@$0.75
Pages 11-20
@$0.50
Pages 21 -
@$0.25
Delivery: Delivery / postage fees
additional depending upon
delivery type.
Circle One: Under penalty of N.J.S.A. 2C:28-3, I certify that I HAVE / HAVE NOT been convicted of any
indictable offense under the laws of New Jersey, any other state, or the United States.
Extras:
Date
Signature
Pages 1-10
Extraordinary service fees
dependent upon request.
Record Request Information: To expedite the request, be as specific as possible in describing the records being requested. Also, please
include the type of access requested (copying or inspection), and if data, the medium requested.
STATE USE ONLY
Est. Document Cost
Est. Delivery Cost
STATE USE ONLY
Disposition Notes
Custodian: If any part of request cannot be
delivered in seven business days,
detail reasons here.
Est. Extras Cost
STATE USE ONLY
Tracking Information
Final Cost
Tracking #
Total
Rec’d Date
Deposit
Ready Date
Balance Due
Balance Paid
Total Pages
Records Provided
Total Est. Cost
Deposit Amount
Estimated Balance
Deposit Date
In Progress
-
Open
Denied
-
Closed
Filled
-
Closed
Partial
-
Closed
Custodian Signature
Date
Requesting Access to Government Records Under the New Jersey Open Public Records Act (N.J.S.A. 47:1A-1 et seq.)
1. In order to request access to government records under OPRA, you must complete all the required portions of and date this
request form and deliver it in person during regular business hours or by mail, fax or electronically to the appropriate
custodian of the record requested. Your request is not considered filed until the appropriate custodian of the record requested
has received a completed request form. If you submit the request form to any other officer or employee of the Department of
Agriculture, that officer or employee does not have the authority to accept your request form on behalf of the Department of
Agriculture and you will be directed to the appropriate division custodian. Descriptions of the divisions and agencies of the
Department of Agriculture can be found at www.state.nj.us/agriculture.
2. If you submit a request for access to government records to someone other than the appropriate custodian, do not complete the
Department of Agriculture request form, or attempt to make a request for access by telephone or fax; the Open Public
Records Act and its deadlines, restrictions and remedies will not apply to your request.
3. The fees for duplication of a government record in printed form are listed on the front of this form. We will notify you of any
special charges, special service charges or other additional charges authorized by State law or regulation before processing
your request. Payment shall be made by cash, check or money order payable to the State of New Jersey.
4. If it is necessary for the records custodian to contact you concerning your request, providing identifying information, such as
your name, address and telephone number or an e-mail address is required. Where contact is not necessary, anonymous
requests are permitted; except that anonymous requests for personal information are not honored.
5. A 50% deposit must accompany requests with estimated fees exceeding $25. Anonymous requests, when permitted, require a
deposit of 100% of estimated fees. You agree to pay the balance due upon delivery of the records.
6. Under OPRA, a custodian must deny access to a person who has been convicted of an indictable offense in New Jersey, any
other state, or the United States, and who is seeking government records containing personal information pertaining to the
person’s victim or the victim’s family.
7. By law, the Department of Agriculture must notify you that it grants or denies a request for access to government records
within seven business days after the custodian of the record requested receives the request, provided that the record is
currently available and not in storage. If the record requested is not currently available or is in storage, the custodian will
advise you within seven business days when the record can be made available and the estimated cost. You may agree with the
custodian to extend the time for making records available, or granting or denying your request.
8. You may be denied access to a government record if your request would substantially disrupt agency operations and the
custodian is unable to reach a reasonable solution with you.
9. If the Department of Agriculture is unable to comply with your request for access to a government record, the custodian will
indicate the reasons for denial on the request form and send you a signed and dated copy.
10. Except as otherwise provided by law or by agreement with the requester, if the custodian of the record requested fails to
respond to you within seven business days of receiving a request form, the failure to respond will be considered a denial of
your request.
11. If your request for access to a government record has been denied or unfilled within the time permitted by law, you have a
right to challenge the decision by the Department of Agriculture to deny access. At your option, you may either institute a
proceeding in the Superior Court of New Jersey or file a complaint in writing with the Government Records Council (GRC).
You may contact the GRC by toll-free telephone at 866-850-0511, by mail at PO Box 819, Trenton, NJ, 08625, by e-mail at
[email protected], or at their web site at www.state.nj.us/grc. The Council can also answer other questions about the law.
12. Information provided on this form may be subject to disclosure under the Open Public Records Act.
13. The following table includes the mailing address for the Records Custodian(s) of the Department of Agriculture.
Mail Address
NJDA
State Agriculture
Development Committee
SONJ-RRF-2
Zip
Telephone
PO Box 330
Market & New Warren Sts.
Street Address
1
Floor
Trenton
City
08625
609-292-6931
PO Box 330
Market & New Warren Sts.
2
Trenton
08625
609-984-2504