- Form #
- CMS R-0235 (66 KB)
- Form Title
- Data Use Agreement (DUA) (Agreement for use of Centers for Medicare and Medicaid Services (CMS) data containing individual-specific information
- Revision Date
- 06/01/2010
- O.M.B. #
- 0938-0734
- O.M.B. Expiration Date
- 12/31/2014
- CMS Manual
- N/A
- Special Instructions
- N/A
