Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Data Management Plan Self-Attestation Questionnaire (DMP SAQ) Modified 1000 1500 0 Form and Instruction CMS-R-235 Data Management Plans Self Attestation Questionnaire (DMP SAQ)
Forms used to update the DUA Information Modified 2800 476 0 Form and Instruction CMS-R-235 DUA Certificate of Disposition
Form and Instruction CMS-R-235 QE DUA Signature Addendum
Form and Instruction CMS-R-235 NDTR DUA Signature Addendum
Form and Instruction CMS-R-235 Contractor DUA Signature Addendum
Limited Data Set Data Use Agreement (DUA) Modified 500 210 0 Form and Instruction CMS-R-235 Limited Data Set Data Use Agreement (DUA)
Form and Instruction CMS-R-235 LDS DUA Signature Addendum_
Form and Instruction CMS-R-235 LDS DUA Request Application
RIF Request Packet Modified 3455 1624 0 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
Form and Instruction CMS-R-235 RIF Extenstion Request Form
Form and Instruction CMS-R-235 RIF DUA Signature Addendum
Total burden requested under this ICR: 7755 3810 0  
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