How to Make a Freedom of Information Act (FOIA) Request

This section provides instructions on obtaining records within CMS possession, custody and control through the Freedom of Information Act and several links to information and/or documents that are useful to the requester.

 How to Make a Freedom of Information Act (FOIA) Request

The following applies to any and all FOIA requests submitted:

1. Requesting a list of physicians that do not submit their bills to Medicare in an electronic format.

2. Requesting a copy of records on yourself.

3. Requesting a copy of records on someone other than yourself.

4. Requesting a copy of records on all other CMS/Medicare/Medicaid program matters.

Any individual may submit a FOIA request to CMS by mail, fax or in person.

Making a written FOIA reuest by mail is easy. You need no form. We have, however, provided one as a courtesy and as a guide. Mark both the envelope and its contents: "FREEDOM OF INFORMATION ACT REQUEST."

The request must be in writing with an AFFIXED SIGNATURE.

We do not accept requests via telephone. Please, do not include a self-addressed stamped envelope (SASE) envelope nor a check or any type of payment with your initial request. If processing fees apply, an invoice will be issued to you.

You may address your request to:

1. Centers for Medicare & Medicaid Services
    Office of Strategic Operations and Regulatory Affairs
    Freedom of Information Group
    Room N2-20-16
    7500 Security Boulevard
    Baltimore, Maryland 21244-1850

2. Any CMS component that you believe may have the records you seek. (see www.cms.hhs.gov or www.medicare.gov)

3. Any one of the ten CMS Regional Offices

4. Any one of CMS' Medicare Intermediaries and Carriers.

Within your request, identify the record(s) that you want. If you do not know the exact title of the record(s), you should provide a reasonable description of the record. The more details that you can provide about the record, such as its author, date, subject matter and location, if you know them, the better. Not having a good description could delay our response or prevent us from finding the records you want. We may ask you to clarify your request if we need more inforomation to find the record(s).

1) Requesting a list of physicians that do not submit their bills to Medicare in an electronic format

Please provide the name of the specific city and state and ZIP codes (if you know the ZIP codes) that you want those records to include. PLEASE SIGN YOUR REQUEST and provide a return address and phone number where you can be reached should we need to contact you to clarify your request. Fees may be assessed. If the fees are under $25.00, there will be no charge. If the estimate of costs to process your request is $250 or more, staff are to notify you to confim your willingness to pay, before releasing the records to you.

2) Requesting a copy of records on yourself

If you are requesting your own record(s), we will process your request in compliance with the Privacy Act and the Freedom of Information Act. Your signature on your request will be sufficient and you need not provide a consent authorization form.

3) Requesting a copy of records on someone other than yourself

If you are requesting another person's records you will need that person's written and signed consent to disclose those records to you. Please provide your signed FOIA request letter and a copy of the signed consent, to either 1) The Freedom of Information Group in Baltimore, MD. or any unit within the Centers for Medicare and Medicaid Services that you believe may have those records; 2) any one of CMS 10 Regional Offices; 3) any one of CMS contractors that you believe may have those records. The consent authorization document must adhere to the following criteria:

Core Elements and Required Statements of a Valid Authorization

A Valid Authorization Must Contain The Following Elements:

1. The signature of the individual and date. If the authorization is signed by a personal representative of the individual, proof of his/her authority to represent must be attached to the authorization.
2. The name and other specific identification of the person(s) or class of persons authorized to make the requested disclosure.
3. A description of the information to be disclosed that identifies the information in a specific and meaningful fashion.
4. The name or other specific identification of the person(s) or class of persons to whom the requested disclosure is to be made.
5. An expiration date or an expiration event that relates to the individual or the purpose of the disclosure. (If no time frame is given, we must assume that the consent is for a one-time-only disclosure).
6. A description of the purpose of the requested disclosure. The statement “at the request of the individual” is a sufficient description of the purpose when the beneficiary initiates the authorization and does not, or elects not to, provide a statement of the purpose); and

A Valid Authorization Must Contain The Following Statements:
(or similar statements that reflect the beneficiary's understanding of the articulated principles)

1. I understand that I have the right to revoke this authorization at any time. I must do so by writing to the same person(s) or class of persons that I directed this authorization to. The revocation will not apply to information that has already been released in response to this authorization.
2. I undertand that my refusal to authorize disclosure of my personal medical information will have no effect on my enrollment, eligibility for benefits, or the amount Medicare pays for the health services I receive.
3. I understand that information disclosed pursuant to this authorization may be re-disclosed by the recipient and may no longer be protected by law.

SOURCE: Transmittal AB-03-147 dated September 26, 2003, and 45 C.F.R. § 5b.9 Prepared by: Freedom of Information Group, CMS (July 12, 2004)

4) Requesting a copy of records on any and all other CMS/Medicare/Medicaid matters

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Page Last Modified: 12/07/2005 1:15:00 PM
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