RIF Application_JobAid

RIF Attachment A_JobAid.pdf

Use Agreement (DUA) Limited Data Set (LDS) Forms Research Identifiable Files (FIF) Forms (CMS-R-235)

RIF Application_JobAid

OMB: 0938-0734

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Instructions for completing the RIF Application
This document: All requesters of Research Identifiable File (RIF) data must complete a RIF application. It

collects information about the requester, the proposed use including detailed study aims, data required, and
dissemination of findings plan. These instructions are for new requests only.

General Instructions
1. Answer every item in the document.
2. Do not alter the layout or content of the document.
3. Submit to ResDAC in Word format.

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Specific Instructions
ATTACHMENT A: RESEARCH IDENTIFIABLE FILE (RIF) APPLICATION

Enter the name of the Requester
listed on the RIF Data Use Agreement
(DUA). The Requester is the individual authorized to sign agreements on
behalf of the requesting organization.
This person is often referred to as the
‘legal signatory’. This person accepts
all terms and conditions in the DUA
and attests that all information contained in the request is accurate.

DUA Requester

Requesting Organization

Study Title

Must match the individual specified in the RIF DUA.

Must match the organization specified in the RIF DUA.

Must match the study title specified in section 3 of the RIF DUA.

STUDY PARAMETERS, EXECUTIVE SUMMARYError! Reference source not found., DISSEMINATION AND REPORTING OF FINDINGS

STUDY PARAMETERS
1. Type of Organization (Requesting Organization)1:
Please check one.

Enter the exact legal name of the
Requesting Organization listed on the
RIF DUA in section 1.

Privacy Board Chair Signature:

Notes:

☐ Non-profit/Academic
☐ Dissertation
☐ For-profit (i.e., participating in CMS’ Innovator Program)
☐ State Agency
☐ Federal Agency

For CMS Use Only

Privacy Board Approval Date:

Enter the exact Study Title listed on
the RIF DUA in section 3.

Check only one box.
Check one box for type of requesting
organization. If student conducting
research under dissertation study,
also check Dissertation.

EXECUTIVE SUMMARY
2.

Study Description

Please describe your study background, objectives, aims, and purpose.
To be approved under current CMS policy, the purpose of your study must be designed in a way that is expected to demonstrate the potential
to improve the quality of life for Medicare beneficiaries/Medicaid recipients/Health Insurance Marketplace consumers or improve the
administration of the Medicare or Medicaid programs or Health Insurance Exchanges, including payment related projects.

E Click or tap here to enter text.
3.

Please describe any data limitations:

For example, noting that the data does not contain information regarding services not covered by, or billed to, Medicare and how that might
affect the results. It is better to show that consideration has been given to what the potential limitations are rather than have reviewers
assume that the researcher was not aware any existed.

F Click or tap here to enter text.

Data Files Needed

For each file, record the data file EPPE code, data file name, justification for requesting the data file, frequency of data being requested,
indicate if the data being requested can be framed as a reuse of data obtained (or a subset of such data) under an existing DUA, if so from
what DUA, the cohort of the data requested (ex: 5%, 20%, 100%, custom cohort), and the method of dissemination.

The Requesting Organization type impacts the application pathway. Please visit the ResDAC website (www.resdac.org) to learn more.

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ATTACHMENT A: RESEARCH IDENTIFIABLE FILE (RIF) APPLICATION
For CMS Use Only

In at least three to four paragraphs, provide a comprehensive description of the
proposed study that includes:
• Brief background
• Clear objectives and aims
• Clear statement of the study purpose

Privacy Board Approval Date:

Privacy Board Chair Signature:

Notes:

DUA Requester

Requesting Organization

Study Title

Must match the individual specified in the RIF DUA.
Must match the organization specified in the RIF DUA.
Must match the study title specified in section 3 of the RIF DUA.

STUDY PARAMETERS, EXECUTIVE SUMMARYError! Reference source not found., DISSEMINATION AND REPORTING OF FINDINGS
STUDY PARAMETERS
1. Type of Organization (Requesting Organization)1:
Please check one.

☐ Non-profit/Academic
☐ Dissertation
☐ For-profit (i.e., participating in CMS’ Innovator Program)
☐ State Agency
☐ Federal Agency

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In one to two paragraphs, clearly describe any limitations to the requested
data for the study purposes and how
those limitations will be overcome.

EXECUTIVE SUMMARY
2.

Study Description

E Click or tap here to enter text.

Please describe any data limitations:

F Click or tap here to enter text.

Data Files Needed

The Requesting Organization type impacts the application pathway. Please visit the ResDAC website (www.resdac.org) to learn more.

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ATTACHMENT A: RESEARCH IDENTIFIABLE FILE (RIF) APPLICATION

Each row must only contain a single
combination of exact file name, cohort
and DUA. If a request has more than
one combination for a specific file
name, each needs to be a separate row.
If additional rows are needed, click in
the last row of the table, then on the ‘+’
in the lower right area of the table. The
contents of this table must be consistent with the specification worksheet.

Add rows to the table as needed by clicking on the ‘+’ in the lower right of the table.
Data File
Data File Name
Justification for how each data file
Years/Quarters
EPPE Code
will be used in the analysis
Requested2

DUA #
(reuse only)

Dissemination

Please describe your cohort and how it is the minimum necessary to achieve your research objectives.
Include estimated cohort size.

I Click or tap here to enter text.
6.

If this study will require future years of CMS data that are not yet available for request, please list those CMS data files and
years that will be required for the entire scope of your study
(Note: Approval of data files for years that are not yet available will NOT be granted at this time, the information included here will simply
provide CMS with an overview of your study).

J Click or tap here to enter text.

Please list any other data files or sources of information that you are planning to use to support your research study. (e.g.,
Provider of Services (POS) file, AMA Physician Master file, etc.). If you will be linking or attempting to link to the CMS files
specified in section 5, please describe how you will be linking the data.
Name of additional files

Insert the full file name. Only include
one file name per row.

Cohort

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Insert the data file EPPE code. Data file
EPPE codes can be found on the RIF
specifications worksheet or on the final
reuse DUA found in the EPPE system/
your internal documentation. If you are
unable to locate the EPPE codes from
these sources, please contact ResDAC.

Purpose for using the data file in the analysis

If linking to CMS data, describe how linkage will
occur

In one to two sentences, describe how
the file will be used in your study.

Please refer to the ResDAC website for information on data file availability.

Insert the years/quarters of data currently being requested. Do not add future data that is not currently available
for request, as noted in the ResDAC file
availability table.

Select from the drop down menu
whether the data are a % cohort, such
as a 5%, 20%, 100%, or a custom cohort.

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ATTACHMENT A: RESEARCH IDENTIFIABLE FILE (RIF) APPLICATION

If reusing data, enter the DUA number you are reusing from. Otherwise,
leave blank.

Cohort

DUA #
(reuse only)

Dissemination

Indicate whether you will receive
physical data or use the VRDC.

I Click or tap here to enter text.
6.

J Click or tap here to enter text.

List non-CMS data files or CMS public
use files that will be used with the
data or linked to the data. Leave
blank if there are none.

Purpose for using the data file in the analysis

If linking to CMS data, describe how linkage will
occur

Please refer to the ResDAC website for information on data file availability.

List the CMS data files and years not
currently available that will be requested in the future. This helps CMS
understand the scope of the study.

Include estimated cohort size.

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Describe the criteria used to define
the cohort for the project and how
the data being requested is the minimum amount of data needed to complete the study. Include the estimated
cohort size (when known).

Please describe your cohort and how it is the minimum necessary to achieve your research objectives.

For each file, specify in one to two
sentences how the data will be used.

In one to two sentences, clearly describe how any linking will occur. Include a description of the identifiers/
data elements needed for the linkage.
If not linking, insert N/A.

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ATTACHMENT A: RESEARCH IDENTIFIABLE FILE (RIF) APPLICATION

Note all relevant supplements you will
be completing for this request.

Check only one box. If it is funded by a
for-profit entity, check either the first
or third box. If it is not funded by a
for-profit entity, check the second box.
Read statement and check the box.

Please check all that are applicable to your data request and ensure that the relevant supplements are completed
(Note: The supplements will be incorporated by reference into the Data Use Agreement; the Key Personnel Supplement is not
listed since it is required for all Data Use Agreements):
☐ CMS Innovator Program Supplement
☐ State Agency Supplement
☐ Collaborating Organization Supplement
The Requesting Organization attests that they will limit data sharing with any entity to analytic results that meet the CMS cell
suppression policy and are de-identified under the HIPAA Privacy Rule as described at 45 CFR 164.514(b) and will retain the
right to independently prepare publications of the study results. Any aggregated analytic results that are shared must be
limited to only interim results that support the research results that will be made publicly available.
☐ I attest

10. If researchers from the Requesting Organization will be accessing CMS data in the Virtual Research Data Center (VRDC), the
Requester attests that they understand and will adhere to the CMS VRDC Terms of Use and the CMS VRDC Output Review
Policy and will submit a signed DUA Signature Addendum for Research Identifiable Files Acquired from CMS for each VRDC
Seat Holder.
☐ I attest
☐ Not applicable, researchers will not be accessing CMS data in the Virtual Research Data Center

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Review statement and check the box
to agree.

Check the first box if using the VRDC or
the second box if requesting physical
data.

DISSEMINATION AND REPORTING OF FINDINGS

11. From sections 5 (b) and (c) of the CMS DUA, “As a condition of its receipt of CMS data, the Requesting Organization affirms
that it will ensure that its own and any contractors, agents, and/or collaborators use of any data received under this
agreement and other documents governing this data disclosure, or any derivative data, in the creation of any document
(manuscript, table, chart, study, report, etc.) will be de-identified under the HIPAA Privacy Rule as described at 45 CFR
164.514(b) and adhere to CMS policy for cell size suppression. This policy stipulates that no beneficiary(ies)-related data cell
(e.g., admittances, discharges, patients) with a size of 1-10 will be used in publication or other forms of dissemination. The
Requesting Organization will also ensure that no use of percentages or other mathematical formulas will be used in
publications or other forms of dissemination if they result in the display of a beneficiary(ies)-related data cell with a size of 110. "

Q ☐ I agree.

12. What are your plans for publicly disseminating the findings from your analysis, including specific media through which you
will report results?

Click or tap here to enter text.

In one to two paragraphs, provide
a description of how you will make
the findings available to the public.
Describe in detail how and where the
study findings will be made available
to the public and include the names of
the scientific journals or conferences
that will be targeted. Use strong, affirmative language such as “Results will
be...” or “We will submit”.

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File Type	application/pdf
File Title	Instructions for completing the RIF Application
File Modified	2024-12-11
File Created	2024-09-24