Form Cms-R-0235l - Agreement For Use Of Centers For Medicare & Medicaid Services (Cms) Limited Data Sets Page 6

Download a blank fillable Form Cms-R-0235l - Agreement For Use Of Centers For Medicare & Medicaid Services (Cms) Limited Data Sets in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Cms-R-0235l - Agreement For Use Of Centers For Medicare & Medicaid Services (Cms) Limited Data Sets with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Form Approved
CENTERS FOR MEDICARE & MEDICAID SERVICES
OMB No. 0938-0734
ATTACHMENT A
Centers for Medicare & Medicaid Services (CMS)
Research Application Guidelines for Requesting Limited Data Sets
1. Introduction
• Title.
• Purpose:
Provide a detailed explanation of the research purpose of the project. The purpose must demonstrate
■
the potential to improve the quality of life for Medicare beneficiaries or improve the administration
of the Medicare program, including payment related projects. Under the Privacy Rule, permitted
purposes include research, public health and/or health care operations.
What are the potential uses of this project to Medicare providers of service?
■
2. Project Issues and Methods
• List and describe the key issues to be studied.
• Describe the plan to analyze the data for the project, including the methodology and procedures
that will be used.
• Provide an outline of project reports, including types of tabulations, aggregations, and other
data presentations.
• Statement of whether any of the methodology or tools contain proprietary information [proprietary
information is exempt from release requirements under the Freedom of Information Act if it falls
within the scope of Exemption 4, 5 U.S.C. § 552(b)(4)].
3. Data Management Safeguards
• Describe the procedures that will be used to protect the privacy and identity of an individual. For
example, how will the privacy of information of beneficiaries in the files be safeguarded and guaranteed?
• Describe safeguards that would be followed for permitted disclosures of data, if applicable.
4. Key personnel
• List staff that will have access to the limited data set file(s) and their role in the project.
5. Dissemination/Implementation
• Describe how the findings will be used
• Briefly describe any data dissemination plan that includes how the findings and any reported data
elements will be aggregated to a level that does not permit the identification of the individual.
• Describe the type of data that will be disseminated, if applicable.
6. Proprietary Information
• If the Research Application provided by the Requesting Organization contains proprietary information,
a statement to that effect must be included in the Research Application submitted to CMS. Proprietary
information is exempt from release under the Freedom of Information Act if it falls within the scope of
Exemption 4, 5 U.S.C. § 552(b)(4).
Form CMS-R-0235L (02/08)
6

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Cms-r-0235u - Data Use Agreement (dua)- Update To Existing Dua - Agreement For Use Of Centers For Medicare & Medicaid Services (cms) Data Form Cms-r-0235u - Data Use Agreement (dua)- Update To Existing Dua - Agreement For Use Of Centers For Medicare & Medicaid Services (cms) Data Medical
Form Cms-r-0235a - Data Use Agreement (dua) Addendum For Data Acquired From The Centers For Medicare & Medicaid Services (cms) 2012 Form Cms-r-0235a - Data Use Agreement (dua) Addendum For Data Acquired From The Centers For Medicare & Medicaid Services (cms) 2012 Legal
Form Cms-r-0235 - Agreement For Use Of Centers For Medicare & Medicaid Services (cms) Data Containing Individual Identifiers Form Cms-r-0235 - Agreement For Use Of Centers For Medicare & Medicaid Services (cms) Data Containing Individual Identifiers Medical
Form Cms-10252 - Data Use Agreement (dua) Certificate Of Disposition (cod) For Data Acquired From The Centers For Medicare & Medicaid Services (cms) Form Cms-10252 - Data Use Agreement (dua) Certificate Of Disposition (cod) For Data Acquired From The Centers For Medicare & Medicaid Services (cms) Medical
Cms-1539 - Centers For Medicare & Medicaid Services Cms-1539 - Centers For Medicare & Medicaid Services Medical
Centers For Medicare & Medicaid Services (cms) Inpatient Prospective Payment System (ipps) Quality Reporting Programs Centers For Medicare & Medicaid Services (cms) Inpatient Prospective Payment System (ipps) Quality Reporting Programs Medical
Centers For Medicare & Medicaid Services - Freedom Of Information Act Request Centers For Medicare & Medicaid Services - Freedom Of Information Act Request Business
Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (cms) Filing Instructions For The 2015 Mlr Reporting Year - Centers For Medicare & Medicaid Services (cms) Medical
Scope Of Sales Appointment Confirmation Form - Centers For Medicare & Medicaid Services Scope Of Sales Appointment Confirmation Form - Centers For Medicare & Medicaid Services Medical
Form Cms-724 - Medicare/medicaid Psychiatric Hospital Survey Data Form Cms-724 - Medicare/medicaid Psychiatric Hospital Survey Data Medical

Related Categories

Parent category: Medical
Download
Go
Page of 6