Request Form

The IHS' Privacy Policy states that we collect no information about you, other than information automatically collected and stored (see below), when you visit our web site unless you choose to provide that information to us. Information being obtained through this portion of the Agency's website for FOIA purposes will ONLY be used to respond to any FOIA request that is made; or any email that may be transmitted via this site to the proper FOIA Staff that requires a response from one of the program staff. Your personal information is protected and never shared. Please note that under Federal law, when you make a FOIA request, that request becomes public information. IHS does not require you to send us via email (unless encrypted) your Social Security Number (SSN) but any other personally identifiable information (PII) contained in your request will be protected and will NOT be made public (e.g., home address, telephone number, home email address, Medical Record Numbers, personnel and pay information, etc.).