Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Data Management Plan Self-Attestation Questionnaire (DMP SAQ) New 1000 1500 0 Form and Instruction CMS-R-235 Data Management Plans Self Attestation Questionnaire (DMP SAQ)
Forms used to update the DUA Information New 5600 952 0 Form and Instruction CMS-R-235 Data Use Agreement (DUA) Signature Addendum
Form and Instruction CMS-R-235 DUA Update to Existing Data Use Agreement
Form and Instruction CMS-R-235 DUA Certificate of Disposition
Limited Data Set Data Use Agreement (DUA) New 350 175 0 Form and Instruction CMS-R-235 Limited Data Set Data Use Agreement (DUA)
RIF Request Packet Modified 2705 1249 0 Form and Instruction CMS-R-235 Data Use Agreement (DUA)
Form and Instruction CMS-R-235 RIF Request Application
Form and Instruction CMS-R-235 State Agency Supplement
Form and Instruction CMS-R-235 Innovator Supplement
Form and Instruction CMS-R-235 Collaborator Supplement
Form and Instruction CMS-R-235 Key Personnel Supplement
Form and Instruction CMS-R-235 Amendment Request Form
Total burden requested under this ICR: 9655 3876 0  
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