Sample Foia Request Letter Template printable pdf download

SAMPLE FOIA REQUEST LETTER

A sample FOIA request letter is shown below. Keep a copy of your request. You may need to

refer to it in further correspondence with the agency.

Date

CMS FOIA Officer

Centers for Medicare & Medicaid Services

Mailstop N2-20-16

7500 Security Boulevard

Baltimore, MD 21244

Dear __________________:

Under the Freedom of Information Act, 5 U.S.C. subsection 552, I am requesting access to

[identify the records as clearly and specifically as possible].

In order to help you determine my status for the purpose of assessing fees, you should know that

I am [insert one of the descriptions below]

a representative of the news media affiliated with the ______________ news

organization and this request is made as part of news gathering and not for commercial

use.

affiliated with an educational or noncommercial scientific institution, and this request is

made for a scholarly or scientific purpose and not for a commercial use.

affiliated with a private business and am seeking information for use in the company’s

business.

an individual seeking information for personal use and not for a commercial use.

[Optional] I am willing to pay fees for this request up to a maximum of $__. If you estimate that

the fees will exceed this limit, please inform me first.

[Optional] I request a waiver of all fees for this request. Disclosure of the requested information

to me is in the public interest because it is likely to contribute significantly to public

understanding of the operations or activities of the government and is not primarily in my

commercial interest. [Include specific details, including how the requested information will be

disseminated by the requester for public benefit.]

[Optional] I request that the information I seek be provided in electronic format, and I would like

to receive it on a personal computer disk [or a CD-ROM].

[Optional] I ask that my request receive expedited processing because ____. [Include specific

details concerning your “compelling need,” such as being someone “primarily engaged in

Sample Foia Request Letter Template