OMB control number
FOIA/Privacy Act Requests for Medicare Claims Data via CMS FOIA Public Portal (CMS-10781)
OMB 0938-1419 · HHS/CMS.
OMB 0938-1419
This collection of information is dedicated to Medicare beneficiaries and third party requesters (law firms or others) acting on behalf of beneficiaries that are making requests for CMS to produce Medicare beneficiary records through 5 U.S.C. § 552(b) (See also 42 C.F.R. § 401.136). Currently the requests are mailed / faxed / emailed to CMS. The new online portal will allow for ease and efficiency to upload the request and required authorization, which will be quickly and securely sent directly to CMS.
The latest form for FOIA/Privacy Act Requests for Medicare Claims Data via CMS FOIA Public Portal (CMS-10781) expires 2029-04-30 and can be found here.
Latest Forms, Documents, and Supporting Material
Document Name |
|---|
Form and Instruction |
Supporting Statement A |
Form CMS-10781 Request Process
CMS-10781_Supporting_Statement_Part_A (30-day).docx
Request Process All Historical Document Collections
| Reinstatement without change of a previously approved collection | 2025-11-25 | ||
|
Approved without change |
New collection (Request for a new OMB Control Number) | 2021-10-20 |