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FOIA Request Form

Contact Information













Association

Are you representing the interest of another individual?

First-party request means a request by an individual for records pertaining to that individual, or an authorized representative acting on such an individual's behalf.


Fee Category

Type of requester:

Commercial use means a use or purpose that furthers a commercial, trade, or profit interest of the requester or the person or entity on whose behalf the request is made.

Fee category means one of the four categories established by the FOIA to determine whether a requester will be charged fees for search, review, and duplication. The categories are: commercial use requests; non-commercial scientific or educational institutions requests; news media requests; and all other requests. Fee categories are further explained in the Department of Health and Human Services FOIA regulations at §5.53.


Request

FOIA request means a written request that reasonably describes the records sought.

Requested format of responsive records:


Fees

Please read before selecting: Fee waiver means the waiver or reduction of fees if a requester is able to demonstrate that certain standards set forth in the FOIA and this part are satisfied, including that disclosure of the records 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 the commercial interest of the requester.

Are you willing to pay fees?

Are you requesting a fee waiver?

Expedited Processing

Please read before selecting: Expedited processing means the process set forth in the FOIA that allows requesters to request faster processing of their FOIA request, if they can demonstrate a specific compelling need.

Are you requesting expedited processing?


If you have questions regarding the submission of or how to fill out this form you may contact the Indian Health Service FOIA Office at:

Janet Ingersoll
Government Information Specialist
Phone: 301-443-6177

Monique Hartgrove
Government Information Specialist
Phone: 301-945-3197