Get Form Cms-r-0235 (agreement For Use Of Centers For ... - Hipaaspace

Filling out the Form Cms-r-0235, an essential agreement for accessing Centers for Medicare & Medicaid Services data, can be straightforward if approached methodically. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently.

Follow the steps to successfully complete the Form Cms-r-0235.

1. Press the ‘Get Form’ button to obtain the form and open it in the editor for completion.
2. In the first paragraph, enter the Requestor’s organization name as it formally appears.
3. In Section 1, re-enter the Requestor’s organization name to ensure consistency.
4. In Section 4, specify the Study and/or Project name and include the CMS contract number, if applicable.
5. For Section 5, detail the files and years you are requesting access to. If file names are unclear, consider contacting a CMS representative for clarification.
6. In Section 6, provide the anticipated date of completion for the Study/Project.
7. Proceed to Section 12 and fill it out as designated for the User.
8. Complete Section 16, which requires input from the Requestor.
9. For Section 17, enter the Custodian’s name, company/organization, address, phone number (with area code), and email address if applicable, even if the Custodian is also the Requestor.
10. Section 18 will be finished by a CMS representative.
11. In Section 19, indicate if your study is funded by other Federal Agencies by entering the name of such agency. Complete the required signatures in this section.
12. Sections 20a and 20b will be filled out by a CMS representative.
13. If there are additional custodians who will access CMS identifiable data, complete the Addendum, CMS-R-0235A.
14. Finally, save any changes made, and you will have the option to download, print, or share the completed form for submission.

Start filling out the Form Cms-r-0235 online today to ensure efficient access to necessary CMS data.