1805.1 Form of Request
A request to remove PII must be made in writing. It should be clearly labeled as a “Request to Remove PII,” and it must include the following information:
• The copyright registration number(s) associated with the record(s).
• The name of the author and/or claimant of record on whose behalf the request is made.
• A statement identifying the specific PII that is to be removed or replaced.
NOTE: If the request involves the name of the author or claimant or the claimant’s address, see Sections 1805.1 (A) and 1805.1 (B) for additional guidance.
• Verifiable substitute non-personally-identifiable information that should replace the PII to be removed, where applicable.
• A statement providing the reasons supporting the request.
NOTE: If the request does not include verifiable substitute non-personally- identifiable information, see Section 1805.1 (C) for additional guidance.
• The statement “I declare under penalty of perjury that the foregoing is true and correct.”
• If the request is submitted by an authorized representative of the author or claimant of record, an additional statement that “I am authorized to make this request on behalf of [name of author or claimant of record].”
• A telephone number.
• An email address (if available).
• A physical mailing address to which the Office’s response may be sent (if no email address is provided).
The request must be signed and dated by the author, claimant of record, or the duly authorized agent of the author or claimant of record. It must be accompanied by the filing fee described in Section 1805.2, and these items must be sent to the address specified in Section 1805.3.
See generally 37 C.F.R. § 201.2 (E) (3).