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(
*
) Marked Fields are Mandatory.
Name of the office or Department to which the information relates
Complaint Received On
Department Name
*
Select Department
NA
Agriculture
Revenue
Others
Information & Public Relation
Public Enterprises
Rural Development
Sports & Youths Services
Labour & Employment
Commerce & Transport (Com)
Commerce & Transport (Transport)
Cooperation
Energy
Excise
Finance
Food Supply & C.W.
Forest & Environment
General Admin
Health & Family Welfare
Higher Education
Home
Housing & Urban Dev
Industries
Information Technology
Law
P.G.& P.A.
Panchayati Raj
Planning & Coordination
School & Mass Edn
Science & Technology
S.T. & S.C. Dev
Steel & Mines
Textiles & Handlooms
Tourism & Culture (Tourism)
Tourism & Culture (Culture)
Water Resource
Women & Child Dev
Works
Fisheries & ARD
Parliamentary Affairs
Office / Public Authority
*
Select Office/Public Authority
Complainant's Particulars
Full Name
*
Mr.
Mrs.
Ms.
Miss.
Shri.
Smt.
Dr.
Citizen Status
Indian
NRI/Person of Indian Origin
Residing Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua And Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia And Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia (Local Name: Hrvatska)
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
France, Metropolitan
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island & Mcdonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People'S Republic Of
Korea, Republic Of
Kuwait
Kyrgyzstan
Lao People'S Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia, The Former Yugoslav Republic Of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States Of
Moldova, Republic Of
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts And Nevis
Saint Lucia
Saint Pierre And Miquelon
Saint Vincent And The Grenadines
Samoa
San Marino
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Senegal
Seychelles
Sierra Leone
Singapore
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Slovenia
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South Africa
Spain
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Sudan
Suriname
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Switzerland
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Tanzania, United Republic Of
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Togo
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Uganda
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Uruguay
Uzbekistan
Vanuatu
Vatican City State (Holy See)
Venezuela
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis And Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
Is the Complainant Below Poverty Line(BPL)?
Yes
No
Contact Details
Complete Address
*
State / UT
ORISSA
KARNATAKA
MAHARASTRA
WEST BENGAL
BIHAR
TAMILNADU
HARIYANA
ANDHRA PRADESH
JHARKHAND
DELHI
SINGHBHUM
RAIPUR
ASSAM
CHHATTISGARH
GUJARAT
HIMACHAL PRADESH
KERALA
MEGHALAYA
NAGALAND
PUNJAB
SIKKIM
TRIPURA
UTTARANCHAL
ARUNACHAL PRADESH
GOA
CHANDIGARH
ANDAMAN & NICOBAR
DAMAN & DIU
DADAR & NAGAR HAVELI
JAMMU & KASHMIR
LAKSHDWEEP
MADHYA PARDESH
MANIPUR
MIZORAM
PONDICHERRY
RAJASTHAN
UTTAR PRADESH
District
Select District
ANGUL
ANGUL
BALANGIR
BALANGIR
BALASORE
BALASORE
BARGARH
BARGARH
BHADRAK
BHADRAK
BOUDH
BOUDH
CUTTACK
CUTTACK
DEOGARH
DEOGARH
DHENKANAL
DHENKANAL
GAJAPATI
GAJAPATI
GANJAM
GANJAM
JAGATSINGHPUR
JAGATSINGHPUR
JAJPUR
JAJPUR
JHARSUGUDA
JHARSUGUDA
KALAHANDI
KALAHANDI
KANDHAMAL
KANDHAMAL
KENDRAPARA
KENDRAPARA
KEONJHAR
KEONJHAR
KHURDA
KHURDA
KORAPUT
KORAPUT
MALKANAGIRI
MALKANAGIRI
MAYURBHANJ
MAYURBHANJ
NAWAPARA
NAWAPARA
NAWRANGPUR
NAWRANGPUR
NAYAGARH
NAYAGARH
PURI
PURI
RAYAGADA
RAYAGADA
SAMBALPUR
SAMBALPUR
SUBARNAPUR
SUBARNAPUR
SUNDARGARH
SUNDARGARH
Name of City / Town / Village
PIN / ZIP/ Area Code
Contact No.
Fax
Email ID
*
Details of Public Information Officer (PIO) approached, if any
Have you applied to any PIO for Information related to this complaint
Yes
No
Name
*
Address
Designation
Contact No.
Email ID
Response Type
No Response
Refused To Accept
Info. Denied
Unsatisfactory Response
Partial Sharing of info.
Demanded Unreasonable Fee
Details of First Appellate Authority (FAA) approached, if any
Have you applied to any FAA for Information related to this complaint
Yes
No
Name
*
Address
Designation
Contact No.
Email ID
Response Type
No Response
Both Parties Heard
Pending
Allowed
Disposed Of
Decision given within the time Stipulated
Info. Denied
Not Satisfactory
Dismissed
Complainant Details
Does it Pertain to the
Life or Liberty of a citizen?
Yes (Urgent)
No (Normal)
Are you a
Senior Citizen?
( above 65 years)
Yes
No
(Attach document in support of your age)
Are you
Differently Abled?
Yes
No
(Attach relevant document )
Please enter the Complaint Description
(if you have text in electronic form simply, copy and paste here)
Fees Deposited (
Exempted only for BPL
)
Yes
No
Exempted
Case Filed On
Supporting Documents
Document Name
Date
Upload Soft Copy
Copy of Form A
*
(1st Applied Date)
(Last Applied Date)
Copy of Receipt in Support of payment of fees for Submission of Form A application
Copy of Appeal Memo of 1st Appeal in Form 'D'
Response of PIO Date & File
Copy of Order of the FAA
Copy of Form E (RTI Act 2005)
Upload atleast one of the following Document
Copy of Proof of Refusal to Provide any information
OR
Copy of Proof of no response to a request for information within time limit
OR
Copy of proof of demand of excess fees, or unreasonable fees
OR
Copy of proof of supply of incomplete, false or misleading information