CMS-R-235 Innovator Supplement

RESEARCH IDENTIFIABLE FILE (RIF) REQUEST APPLICATION: CMS INNOVATOR PROGRAM SUPPLEMENT

Requester
Must match the individual specified in the RIF DUA.
Requesting Organization
Must match the organization specified in the RIF DUA.
Study Title
Must match the study title specified in section 3 of the RIF DUA.

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I understand that as part of a research study, it is permissible under the Innovator research program to create products or
tools we intend to sell or to create analyses related to our own business needs.

1.

Describe the product, tool or analyses to be created:

2.

Describe the target audience:

1