Form CMS-R-0235A Data Use Agreement (Dua) Signature Addendum for Data Acquired From the Centers for Medicare & Medicaid Services (Cms)

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Form CMS-R-0235A Data Use Agreement (Dua) Signature Addendum for Data Acquired From the Centers for Medicare & Medicaid Services (Cms)

What Is Form CMS-R-0235A?

This is a legal form that was released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services on June 1, 2012 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is a Form CMS-R-0235A?
A: Form CMS-R-0235A is a Data Use Agreement (DUA) Signature Addendum for data acquired from the Centers for Medicare & Medicaid Services (CMS).

Q: What is the purpose of Form CMS-R-0235A?
A: The purpose of Form CMS-R-0235A is to establish an agreement between the user and CMS for the use and protection of CMS data.

Q: What is a Data Use Agreement (DUA)?
A: A Data Use Agreement (DUA) is a legally binding document that governs the use and protection of data acquired from CMS.

Q: Who should use Form CMS-R-0235A?
A: Form CMS-R-0235A should be used by individuals or organizations who acquire data from CMS and need to establish a data use agreement.

Q: What information is required in Form CMS-R-0235A?
A: Form CMS-R-0235A requires the user's name, organization, address, contact information, and signature.

Q: Is Form CMS-R-0235A mandatory?
A: Yes, if you acquire data from CMS, it is mandatory to complete Form CMS-R-0235A to establish a Data Use Agreement (DUA).

Q: What are the consequences of not completing Form CMS-R-0235A?
A: Failure to complete Form CMS-R-0235A may result in the denial of access to CMS data or legal consequences for unauthorized use of the data.

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Form Details:

  • Released on June 1, 2012;
  • The latest available edition released by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form CMS-R-0235A by clicking the link below or browse more documents and templates provided by the U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services.

Download Form CMS-R-0235A Data Use Agreement (Dua) Signature Addendum for Data Acquired From the Centers for Medicare & Medicaid Services (Cms)

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  • Form CMS-R-0235A Data Use Agreement (Dua) Signature Addendum for Data Acquired From the Centers for Medicare  Medicaid Services (Cms), Page 1
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