You may complete the online form below or to make a request by mail or fax.

Title	Choose Title Mr. Mrs. Ms Miss
First name
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Last name
Org./Affil.
Address 1
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Zip code:
Daytime phone
Fax number:
Email address

Description of the documents requested

Although you do not have to give a document's title, you should identify the documents that you want as specifically as possible to increase the likelihood that the agency will be able to locate them. Any facts you can furnish about the time, authors, events, subjects, and other details of the documents will be helpful to the agency in deciding where to search and in determining which records respond to your request, saving you and the government time and money.

Please list, as clearly as possible, the name of the document(s), the type of document(s), and any other specifics you may have that will identify the documents you seek.

Identify the date range of the documents:

Payment of fees

Select the amount you are willing to reimburse the agency for fees incurred which exceed $25.00.

$26.00 - $100.00
$101.00 - $250.00
$251.00 - $500.00

Receipt of Documents

How would you like to receive your documents? (check one)

Paper
CD
Email (if documents are more than 5MB, they will be provided on a CD)

Mail or fax your request

OIG Freedom of Information Officer
Cohen Building, Suite 1062
Department of Health and Human Services
330 Independence Ave, S.W.
Washington, D.C. 20201
Fax: 202-205-4030