How to Make a Privacy Act Request

You may submit a Privacy Act request to HHS concerning any record about you that HHS maintains in a “system of records;” that is, a system from which records about individuals are retrieved by personal identifier. Instructions are provided below for each of the three types of Privacy Act requests:

I. Access to or Notification about the Existence of Records

II. Amendment or Correction of Records

III. Accounting of Disclosures

I. Access to or Notification about the Existence of Records

These instructions explain how to request access to a record about you or to request notification of whether a particular system of records contains a record about you.

If your request is not fully granted under the Privacy Act (5 USC 552a), HHS will process it under the Freedom of Information Act (5 USC 552) and provide you with any information that is not excluded or exempt from access under both Acts.

What do I include in my request?

If making an access request, you may use this access request and consent form, or you may submit a letter containing the same information that you would provide on the form.

No form is provided for a notification request. If making a notification request to determine if a particular system of records contains a record about you, include in your request (1) the applicable System of Records Notice (SORN) name and number and (2) the same information required in the above form for an access request.

Where do I send my request?

You may submit your request to any of the following:

Secure Web Portal:

Requests submitted through the web portal reach us within one business day.

Email:

Please note that email is not considered to be sufficiently secure to safely transmit sensitive information, so please do not use email to submit a sensitive request or sensitive attachments. If you submit your request by email, please send any sensitive information to us separately by mail or the web portal.

Mail:

You may submit your request to any of these mailing addresses. If you submit your request by mail, clearly mark the envelope “Privacy Act/FOIA Request” and be aware that the request may take two weeks to reach us due to secure handling requirements.

  • The Privacy Act Contact or FOIA/PA Requester Service Center of the HHS component that maintains the record, at the address listed at https://www.hhs.gov/foia/contacts/index.html.
  • System Manager of the applicable system of records, if known, at the address indicated in the System of Records Notice (SORN). SORNs are posted at https://www.hhs.gov/foia/privacy/sorns/index.html.
  • HHS FOIA/Privacy Act Division, Hubert H. Humphrey Building – Room 729H, 200 Independence Avenue SW, Washington, DC 20201.

II. Amendment or Correction of Records

Use these instructions to request amendment or correction of a record about you.

What do I include in my request?

  1. Describe the records you are contesting and the amendment or correction you are requesting. Please include the following:
  • A description or copy of each particular record you are seeking to correct or amend.
  • The System of Records Notice (SORN) name and number, to identify the system of records in which the record or records are located. SORNs are posted at https://www.hhs.gov/foia/privacy/sorns/index.html.
  • A statement describing the amendment or correction you are requesting.
  • A statement explaining why you believe the record is not accurate, relevant, timely, or complete.
  • Any additional supporting or helpful documentation.
  1. Verify your identity by providing the following:
  • Your full name.
  • Your current address.
  • Your date and place of birth.
  1. Provide your contact information:
  • Your full mailing address.
  • Your telephone number.
  • Your email address, if available.
  1. Sign your request, and provide one of the following:
  • Your notarized signature or
  • A statement by you that certifies, under penalty of perjury, that you
    • are the individual who you claim to be and
    • understand that knowingly and willfully requesting a record about an individual from an agency under false pretenses is a criminal offense under the Privacy Act, subject to a fine of up to $5,000.
  1. Clearly mark your request letter and any envelope: “Privacy Act Request.”
  2. Provide evidence of your parent/guardian relationship (if applicable).

If you are making the request as the parent or guardian of an individual who is a minor or who is legally incompetent, include the following:

  • A statement by you that you are acting for and making the request on behalf of the subject individual.
  • The subject individual’s name.
  • The subject individual’s current address.
  • The subject individual’s date of birth.
  • A copy of the subject individual’s birth certificate that cites your parentage or a copy of the court order that establishes your guardianship
  1. Provide consent, if you want the HHS response to be sent to someone other than you (optional).

Any consent must contain:

  • Your signature in accordance with (d) above.
  • The date you signed the consent.
  • The name of the person who you want to receive all or any part of HHS’ response to your request.
  • The designated recipient’s full mailing address.
  • The designated recipient’s telephone number and email address, if available.
  • A specific description of the records or information about you that you authorize HHS to disclose to the designated recipient.

Where do I send my request?

Please submit your request to one of the following:

You may submit your request to any of the following:

  • HHS FOIA/Privacy Act Division, Hubert H. Humphrey Building, Room 729H, 200 Independence Avenue, SW, Washington, DC 20201. Please note that requests sent by mail to this address may take two weeks to reach us due to secure handling requirements.

III. Accounting of Disclosures

Use the instructions described below to request an accounting of disclosures that HHS has made which provided access to a record about you to another person, organization, or agency. Please be aware that HHS is not required to provide an accounting of the following types of disclosures:

  • Disclosures for which accountings are not required to be maintained. These are disclosures that are made either 1) to HHS officials and employees who require access to the record to perform their duties or 2) in accordance with the disclosure requirements of the Freedom of Information Act (FOIA).
  • Disclosures to law enforcement agencies for authorized law enforcement activities, which are made in response to written requests from those law enforcement agencies that specify the law enforcement activities for which the disclosures are sought.
  • Disclosures made from law enforcement systems of records that have been exempted from accounting requirements.

What do I include in my request?

  1. Provide the following information about the accounting you are requesting.
  • Identify the system of records in which the records that may have been disclosed are maintained, by providing the System of Records Notice (SORN) name and number. SORNs are posted at https://www.hhs.gov/foia/privacy/sorns/index.html.
  • Describe or provide a copy of any particular records that you are requesting be included in the accounting, if you are limiting your accounting request to particular records about you.
  • Specify any applicable date range(s) to be covered in the accounting.
  1. Verify your identity by providing the following:
  • Your full name.
  • Your current address.
  • Your date and place of birth.
  1. Provide your contact information.
  • Your full mailing address.
  • Your telephone number
  • Your email address, if available.
  1. Sign your request, and provide one of the following:
  • Your notarized signature or
  • A statement by you that certifies, under penalty of perjury, that you
    • are the individual who you claim to be and
    • understand that knowingly and willfully requesting a record about an individual from an agency under false pretenses is a criminal offense under the Privacy Act, subject to a fine of up to $5,000.
  1. Clearly mark your request letter and any envelope: “Privacy Act Request.”
  2. Provide evidence of your parent/guardian relationship (if applicable).

If you are making the request as the parent or guardian of an individual who is a minor or who is legally incompetent, include the following:

  • Your statement that you are acting on behalf of the subject individual in making the request.
  • The subject individual’s name.
  • The subject individual’s current address.
  • The subject individual’s date of birth.
  • A copy of the individual’s birth certificate showing your parentage, or a copy of the court order establishing your guardianship.
  1. Provide consent, if you want the HHS response to be sent to someone other than you (optional).

Any consent must contain:

  • Your signature in accordance with (d) above.
  • The date you signed the consent.
  • The name of the person who you want to receive all or any part of the HHS response to your request.
  • The designated recipient’s full mailing address.
  • The designated recipient’s telephone number and email address, if available.
  • A specific description of the records or information about you that you authorize HHS to disclose to the designated recipient.

Where do I send my request?

You may submit your request to any of the following:

  • HHS FOIA/Privacy Act Division, Hubert H. Humphrey Building, Room 729H, 200 Independence Avenue, SW, Washington, DC 20201. Please note that requests sent by mail to this address may take two weeks to reach us due to secure handling requirements.
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