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SAMPLE FREEDOM OF INFORMATION ACT APPEAL LETTER
A sample FOIA appeal letter is shown below. Keep a copy of your appeal. You may need to
refer to it in further correspondence with the agency.
Principal Deputy Administrator
Centers for Medicare & Medicaid Services
Room C5-16-03
Baltimore, MD 21244-1850
Re: Freedom of Information Act Appeal
Dear

:

This is an appeal under the Freedom of Information Act.
On (date), I requested documents under the Freedom of Information Act. My request was
assigned the following identification number:
_. On (date), I received a response to my
request in a letter signed by (name of official). I appeal the denial of my request.
[Optional] I enclose a copy of that response letter.
[Optional] The documents that were withheld must be disclosed under the FOIA because
(provide details you would want an agency head or appeal officer to consider when deciding
your appeal.)
[Optional] I appeal the decision to deny my request for a waiver of fees. I believe that I am