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 is listed under ICR 202511-0938-015.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10781 CMS-10781.Screenshots for FOIA Beneficiary Portal 508 Compliant | Form and Instruction |
| Form CMS-10781 Request Process | Form and Instruction |
 CMS-10781_Supporting_Statement_Part_A (30-day).docx | Supporting Statement A |
| CMS-10781_Supporting_Statement_Part_A (30-day).docx | Supporting Statement A |
 Request Process |
Form and Instruction |
| Request Process |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202511-0938-015 | Reinstatement without change of a previously approved collection | 2025-11-25 | ||
| 202110-0938-011 | New collection (Request for a new OMB Control Number) | 2021-10-20 | Approved without change |