Fillable Printable Statement of Information Form - New Jersey

Statement of Information Form - New Jersey

Custodian Statement of Information Complainant v. Custodian Agency GRC Complaint No. 200x-xxx

Statement of Information Page 1

State of New Jersey

Government Records Council

Statement of Information Form

This form is to be used by Records Custodians as their response to a complaint filed with

the Government Records Council (“GRC”) alleging the unlawful denial of a request to

access government records under the Open Public Records Act (“OPRA”), N.J.S.A.

47:1A-1 et seq.

An offer to mediate this complaint has been denied by one or more of the parties, or

mediation has not resolved the complaint, and the matter is now within the GRC’s

jurisdiction. The GRC will conduct an investigation as part of the adjudication of the

matter. The Custodian or the Custodian’s Legal Counsel may complete the Statement of

Information. However, the Records Custodian (or alleged Records Custodian) must sign

the Statement of Information. The GRC will also consider any legal briefs, additional

documentation or information submitted with the Statement of Information.

The signed Statement of Information must be returned to:

Government Records Council

In care of [Case Manager’s Name]

101 South Broad Street

P.O. Box 819

Trenton, NJ 08625-0819

Phone: (609) [Case Manager’s Telephone Number]

Fax: (609) 633-6337

E-mail: [Case Manager’s e-mail address]

The Statement of Information must be received no later than five (5) business days

from your receipt of this form. Failure to comply with this deadline may result in the

GRC adjudicating this complaint based only on the information submitted in the Denial

of Access Complaint by the requestor of the records.

Please note that by signing the Statement of Information, the Custodian (or alleged

Custodian) is certifying that a copy will be provided to the Complainant

simultaneously with it being provided to the GRC.

IMPORTANT: Do not provide any records or excerpts of records that the Custodian

claims is privileged or not accessible to the public under OPRA. A general description of

the records’ content will be sufficient.

DEFINITIONS:

“Records request” or “request” refers to the formal OPRA

request on which the complaint is based; “Requestor” or “Complainant” refers

to the person who made the request on which this complaint is based;

“Agency” refers to the public agency or subdivision of that agency to which

the records request was directed; and “Records Custodian” or “Custodian”

refers to the individual charged by the agency with the responsibility for

fulfilling the request for records on which this complaint is based.

Custodian Statement of Information Complainant v. Custodian Agency GRC Complaint No. 200x-xxx

Statement of Information Page 2

PART 1: CONTACT INFORMATION

1. GRC Complaint Number: ____________________________________

2. Name of Complainant: ____________________________________

3. Name of (Alleged) Custodian: ____________________________________

Job Title of (Alleged) Custodian: ____________________________________

4. Custodian’s Public Agency: ____________________________________

Address: ________________________________________________

________________________________________________

Phone: ________________________________________________

Fax: ________________________________________________

E-mail: ________________________________________________

5. Name of Custodian’s Legal Counsel: ____________________________________

Address: ________________________________________________

________________________________________________

Phone: ________________________________________________

Fax: ________________________________________________

E-mail: ________________________________________________

Custodian Statement of Information Complainant v. Custodian Agency GRC Complaint No. 200x-xxx

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PART 2: ABOUT THE DENIAL OF ACCESS COMPLAINT

6. Attach a copy of the OPRA records request upon which this Complaint is based.

Please mark this attachment “Item 6.”

7. Indicate the date on which the Custodian received the OPRA records request upon

which this complaint is based. (If the Custodian did not receive an OPRA records

request, simply indicate “None received.”)

________________________________________________________________________

8. Indicate the date on which the Custodian responded to the OPRA records request

upon which this complaint is based. Provide all written documentation supporting the

Custodian’s response. If you use additional pages to respond, please mark each page

“Item 8.” (If the Custodian did not respond to the OPRA records request, simply

indicate “No response was given.”)

________________________________________________________________________

9. In keeping with the GRC’s statutory mandate to investigate alleged denial of access

complaints pursuant to N.J.S.A. 47:1A-7.e. and the court’s instruction that all

Custodians responding to denial of access complaints provide a document index

containing certain information to the GRC pursuant to its decision in John Paff v. NJ

Department of Labor, 392 N.J. Super. 334 (App.Div. 2007), the Custodian must

provide the document index table below. The document index table is required in

the table format presented below. Please mark the table “Item 9.”

An example of the required document index in table format is as follows:

(A)

List of all

records

responsive to

Complainant’s

OPRA request

(include the

number of

pages for each

record).

(B)

List the Records

Retention

Requirement and

Disposition

Schedule for each

records responsive

to the

Complainant’s

OPRA request

(C)

List of all records

provided to

Complainant, in

their entirety or

with redactions

(include the date

such records were

provided).

(D)

If records were

disclosed with

redactions, give

a general nature

description of

the redactions.

(E)

If records

were denied

in their

entirety, give

a general

nature

description of

the record.

(F)

List the legal

explanation and

statutory citation

for the denial of

access to records

in their entirety

or with

redactions.

Example:

Closed session

minutes for the

May 15, 2006

Council Meeting

Must

retain

agency

permanently.

Disposition

Schedule:

May be archived

only (destruction

not allowed)

Closed session

minutes provided

with redactions on

June 20, 2007 (3

business days after

receiving the

OPRA request).

Redactions were

made only to

delete the

discussion of the

Council members

regarding the

personnel matter

of Jane Doe.

N/A

N.J.S.A.

47:1A

9.a. (allows

exemptions from

disclosure

contained in other

state statutes to

apply under

OPRA) and

N.J.S.A. 10:4-12

(allows governing

Custodian Statement of Information Complainant v. Custodian Agency GRC Complaint No. 200x-xxx

Statement of Information Page 4

bodies to exclude

the public from

discussions of

personnel

matters).

For more clarification of the information required in the document index in table format:

A. An itemized list of all records responsive to the Complainant’s OPRA request that

were made, maintained, kept on file or received by your agency on the date of the

request, regardless of whether you deem such records are exempt from disclosure.

B. State the agency’s Records Retention Period (in years) and Destruction Schedule

(in years) for each record responsive to the request as established and approved by

the New Jersey Department of Treasury, Records Management Services.

C. Of the records responsive to the request, indicate which records, if any, were

provided to the Complainant, in their entirety or with redactions, and the dates

such records were provided.

D. Of the records responsive to the request and provided to the Complainant with

redactions, give a general nature description of the redactions.

E. Of the records responsive to the request, and not provided to the Complainant in

their entirety, give a general nature description of the record.

F. Specifically state the legal explanation and statutory citation (to OPRA or other

law that applies) for such denial based on a public agency’s burden of proving

that all denials of access are authorized by law pursuant to N.J.S.A. 47:1A-6 and

the court’s instruction to provide same in John Paff v. NJ Department of Labor,

392 N.J. Super. 334 (App.Div. 2007).

10. Specifically describe the search undertaken to satisfy the records request upon

which this complaint is based.

11. Specifically state the last date on which documents that may have been responsive

to the request were destroyed in accordance with the Records Destruction Schedule

established and approved by New Jersey Department of Treasury, Records

Management Services.

12. Provide all facts and legal arguments in support of the Custodian’s actions with

regard to the handling of the OPRA records request upon which this complaint is

based on an attached written statement marked “Item 12.”

_______________________________________________________________________

Custodian Statement of Information Complainant v. Custodian Agency GRC Complaint No. 200x-xxx

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If the Custodian fails to complete this form completely and accurately (responding to each numbered

item specifically as directed and providing a document index in table format), this form will be

returned to the Custodian for proper completion thus prolonging the adjudication of the complaint.

By signing this Statement of Information, I certify that:

 I am the Custodian charged by the public agency with the responsibility for

responding to the request for records on which this complaint is based; or

 I am the alleged Custodian of an organization I do not believe to be a public

agency obliged under the provisions of OPRA;

 The documents attached hereto are true copies of all documents sent or received

by the Custodian or the Custodian’s staff (records the custodian claims are

privileged or not accessible to the public under OPRA are not included);

 A copy of this Statement of Information will be provided to the Complainant

simultaneously with it being provided to the GRC; and

 The foregoing statements made by me are true. I am aware that if any of the

foregoing statements made by me are willfully false, I am subject to punishment

pursuant to the New Jersey Court Rule 1:4-4.

Signature: ______________________________________________________

Printed Name: ______________________________________________________

Job Title: ______________________________________________________

Date: ______________________________________________________