Form CMS-10781 CMS-10781.Screenshots for FOIA Beneficiary Portal 508 Co

FOIA/Privacy Act Requests for Medicare Claims Data via CMS FOIA Public Portal (CMS-10781)

CMS-10781.Screenshots for FOIA Beneficiary Portal 508 Compliant

Request Process

OMB: 0938-1419

Document [pdf]
Download: pdf | pdf
CMS/OSORA FOIA Beneficiary Portal

Screenshots for PRA
Submission

FOIA Beneficiary Portal – page 1

Figure 1: Welcome page with “Medicare” selected

FOIA Beneficiary Portal – page 2

Figure 2: Welcome page with “Medicaid” selected

FOIA Beneficiary Portal – page 3

Figure 3: Whose Records page with “Myself” selected

FOIA Beneficiary Portal – page 4

Figure 4: Whose Records page with “Someone Else” selected

FOIA Beneficiary Portal – page 5

Figure 5: Medicare Status page with “No” selected

FOIA Beneficiary Portal – page 6

Figure 6: Medicare Status page with "Yes" selected

FOIA Beneficiary Portal – page 7

Figure 7: Records Type page with "Medicare Advantage claims records" selected

FOIA Beneficiary Portal – page 8

Figure 8: Records Type page with "Prescription Drug claims records" selected

FOIA Beneficiary Portal – page 9

Figure 9: Records Type page with "Social Security Administration documents" selected

FOIA Beneficiary Portal – page 10

Figure 10: Records Type page with "Medicare Secondary Payer lien information" selected

FOIA Beneficiary Portal – page 11

Figure 11: Records Type page with "Other Medicare records" selected

FOIA Beneficiary Portal – page 12

Figure 12: Records type page with "Medicare beneficiary claims records" selected

FOIA Beneficiary Portal – page 13

Figure 13: Contact Info page for self

FOIA Beneficiary Portal – page 14

Figure 14: Contact Info page for request on behalf of someone else (first half)

FOIA Beneficiary Portal – page 15

Figure 15: Contact Info page for request on behalf of someone else (second half)

FOIA Beneficiary Portal – page 16

Figure 16: Record Details page for request for self

FOIA Beneficiary Portal – page 17

Figure 17: Record Details page for request on behalf of someone else

FOIA Beneficiary Portal – page 18

Figure 18: Other Details page

FOIA Beneficiary Portal – page 19

Figure 19: Review page (first half)

FOIA Beneficiary Portal – page 20

Figure 20: Review page (second half)

FOIA Beneficiary Portal – page 21

Figure 21: Request submitted page


File Typeapplication/pdf
File TitleCMS/OSORA FOIA Beneficiary Portal
AuthorJP Janaro
File Modified2025-11-24
File Created2025-09-02

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