REQUEST TO ACCESS PERSONAL INFORMATION Personal Information Protection Act (PIPA) This Request to Access Information document was prepared as an administrative tool intended to assist individuals in understanding the information necessary for an organization to respond to an access to information request made under the Personal Information Protection Act (PIPA). It is not intended as, nor is it a substitute for, legal advice and is not binding on the Office of the Information and Privacy Commissioner of Alberta. For more information see the bottom of this form. CONTACT INFORMATIONName* Title (Optional) Mr.Mrs.MissMs.Dr.Prof.Rev. First Last Name of Company (if applicable)*Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Telephone Number*Fax NumberEmail Address ACCESS REQUESTProvide Sufficient details about the request to enable the organization to identify the requested information.Name of the Organization*Access by:* Receiving a copy of the record Examining the record The time period of the records*Provide specific dates, or date rangeClient Information*Personal information (Intake) Yes No *Contents of client file Yes No Other Information*Computer screen prints of personal information Yes No *Email correspondence Yes No Other records not listed above Yes No Explain:If the same document is held by more than one program, CLG will not provide multiple copies of the records if it is identical.Initials*Date* The Personal Information Protection Act (PIPA or the Act) provides individuals with a right to access their own personal information contained in a record in an organization’s custody or control. Below is a general overview of PIPA in relation to making an access request. For the exact wording and interpretation of PIPA please read the Act in its entirety. A copy of PIPA may be obtained by visiting the Queen’s Printer at: http://qp.alberta.ca.What is "personal information"Personal information is defined in the Act to mean “information about an identifiable individual.” Information must either readily identify the individual, or the identity of the individual can be determined from the information. If the individual cannot be identified, the information is not “personal information” under the Act. Who can make a request Individuals can request access to their own personal information. The Act also provides that a request can be made by the following: - The personal representative of a deceased individual, if related to administration of deceased’s estate - The individual’s guardian or trustee under the Dependent Adults Act, if related to the powers of duties of that guardian or trustee - The individual’s agent under a personal directive, if related to that agent’s powers under the directive - The individual’s attorney under a power of attorney, if related to the powers and duties conferred on that attorney - Any person with written authorization from the individual to act on the individual’s behalf Only an individual has a right to access, but a person other than an individual could make a request on behalf of an individual. Corporations and other entities are not individuals under the ActMaking a request The Act requires that a request for access be made in writing directly to the organization. An individual may ask for a copy of the record, or ask to examine the record containing personal information.The Act does require the individual to provide sufficient detail to enable the organization to identify the requested information.Fees The Act allows an organization to charge a “reasonable” fee in providing an individual access to personal information. Should the organization intend on charging a fee, the organization must give the individual a written estimate.Organizations cannot charge fees when responding to requests for providing access to personal employee information.Time Limits PIPA requires that an organization respond to an individual’s request for access within 45 days of receiving the written request, unless the time limit has been extended as allowed under the Act. The 45-day time limit may be extended if the organization is required to clarify a request, if a large amount of personal information is requested or must be searched, or for other reasons specified in the Act. The organization’s time period for responding does not include days when the organization is waiting for a response from the individual to a fee estimate. The time limit can be affected by lack of clarity in the individual’s request, or as a result of being extended by the organization or with the Commissioner’s permission. The time limit can also be suspended while an organization awaits a response to a fee estimate provided by the individual.Exceptions to access An individual’s right to access personal information under the Act is not unqualified. The Act allows, and in some cases requires, organizations to refuse access to some records or parts of records.Where to send your request An individual must send the written access request directly to the organization that has the custody or control of the records.