RIF Request Packet

Data Use Agreement (DUA) Form, Research Identifiable Files Request Packet Packet, and Data Management Plan (CMS-R-235)

OMB: 0938-0734

IC ID: 8408

Information Collection (IC) Details

View Information Collection (IC)

RIF Request Packet CMS-R-235
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-R-235 Data Use Agreement (DUA) Form-R-0235 DUA.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-R-235 RIF Request Application 02AttachmentA-RIF-Application-508.docx Yes Yes Fillable Fileable
Form and Instruction CMS-R-235 State Agency Supplement 06State-Agency-Supplement-final.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-R-235 Innovator Supplement 05Innovator-Supplement-final.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-R-235 Collaborator Supplement 04Collaborator-Supplement-final.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-R-235 Key Personnel Supplement 03Key-Personnel-final.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-R-235 Amendment Request Form 08RIF-Amendment-final-508.docx Yes Yes Fillable Fileable

Health Health Care Services

 

2,705 0
   
Private Sector Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,705 0 -6,495 0 0 9,200
Annual IC Time Burden (Hours) 1,249 0 -1,651 0 0 2,900
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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