LDS_JobAid

Instructions for completing the Attachment A: Limited Data Set
(LDS) Request Application
This document: All requesters of Limited Data Set (LDS) data must complete an Attachment A: LDS

Request 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.
2.
3.
4.
5.

This is a two-page document.
Answer every item in the document.
Do not alter the layout or content of the document.
Upload the document into EPPE.
The DUA is not finalized until approved by the CMS DMT.

Specific Instructions

A

Enter the name of the DUA Requester. 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. This individual will match the Requester in EPPE.

B

Enter the exact legal name of the Requesting Organization.

C

Enter the exact Study Title. This will match the Study Title in EPPE.

D

Provide a comprehensive Study Description of the proposed
study that includes:
• Brief background
• Clear objectives and aims
• Clear statement of the study purpose

Instructions for completing the Attchment A

A
B
C

D

E

E1: 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.
E2: In one to two sentences, describe how the file will be used in your
study.

F

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, websites or conferences that will be targeted. Use
strong, affirmative language such as “Results will be...” or “We will submit”.

G

E1

In addition to sharing your findings publicly,
please provide details about any products or
tools you plan to develop.

H

Enter the name of your Data Management Plan
(DMP). A DMP is required before receiving LDS
data. To get an approved DMP, contact the Data
Privacy Safeguard Program (DPSP) at
DPSP@cms.hhs.gov.The DPSP team will guide
you through the process. Once completed,
please include your DMP SAQ in the “Data
Management Plans” section of the DUA in EPPE.

F

G

H

Instructions for completing the Attchment A

E2