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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