Crosswalk

LDS/RIF Change Crosswalk
Change

Detailed Information

Reason for Change

LDS Data Use
Agreement

This form provides
information for terms,
conditions, policies,
and regulations.
This form provides
information on the
research study, the
minimum data
necessary to support
the research study, and
how the research
results will be made
publicly available.
Requesters are
required to complete
and sign the DUA
Addendum (PDF) form
as part of the EPPE
process. While the
requester adds
individuals to a DUA
directly in EPPE, CMS
still needs a signed
copy of the DUA
Addendum form for
legal purposes.
The DMP SAQ will
enable CMS to evaluate
researcher data
systems to ensure that
CMS data are
adequately secured
and appropriately
protected, as per the
Privacy Act and the
HIPAA Privacy Rule. The
DMP SAQ
Questionnaire was
updated to add
secondary contact
information.
This form provides
information on the
research study, the
minimum data

Made changes to the
language

Attachment A: Limited
Data Set Request
Application

DUA Signature
Addendums

•
•
•
•
•

RIF
LDS
Contractor
QE
NDTR

Added DMP/SAQ
questionnaire

RIF DUA Attachment A
– RIF Request
Application

Impact on Burden
(none/add/reduce)
none

Made updates to the
language

Add/new

Made updates to the
language

Add/new

Update to reflect
changes to security and
privacy requirements.

none (this form was
already approved, and
this update does not
add to the burden of
the approved form)

Modified Requester to
DUA Requester for
additional clarity.
Added Data File EPPE

None

LDS/RIF Change Crosswalk
necessary to support
the research study, and
how the research
results will be made
publicly available.

Code column to tables
to promote accuracy of
file selection as labeled
in CMS systems.

RIF - Amendment
Request form

This form allows a
requester to amend an
existing DUA, such as
add new data

None

RIF - COD

This form is in another
PRA package and is
used to close a DUA
and certify that data is
destroyed. The form
was updated to request
information on
different destruction
approaches and
consider the different
ways to access CMS
data.
A DUA is valid for one
year and then requires
an extension. The
disclosure of data for
research purposes
requires the research
findings contribute to
generalizable
knowledge. The
extension form
captures the research
findings publication
plan and where
findings are published.

Modified Requester to
DUA Requester for
additional clarity.
Added Data File EPPE
Code column to tables
to promote accuracy of
file selection as labeled
in CMS systems.
Modified Requester to
DUA Requester for
additional clarity.

New form for
requesters to request
an extension,
transitioning from an
email required to
request an extension.

Add/new

RIF Extension Form

None