39 CFR Part 3011, Appendix A

________ , 20____ (date)

On ________ (date non-public materials were initially submitted), non-public treatment was requested for the materials identified as ________ (non-confidential description of non-public materials) (hereinafter “these materials”). Because the non-public treatment of these materials has expired, I request that these materials be disclosed to the public.

Respectfully submitted,

(signature of representative)

(print name of representative)

(address line 1 of representative)

(address line 2 of representative)

(telephone number of representative)

(e-mail address of representative)

(choose the appropriate response)

Attorney/Non-Attorney Representative for

(name of the requestor)

You may delete the instructional text to complete this form and file a request under 39 CFR 3011.401(b).

[85 FR 9644, Feb. 19, 2020]