RIF Executive Summary Template

The Executive Summary is divided into 4 sections:

  1. Executive Summary
  2. Dissemination and Reporting of Findings
  3. Project Staff
  4. Data Management Plan

CMS uses the Executive Summary as the primary document when deciding upon approval. Please answer ALL questions and be thorough with your answers.

Researchers submitting an amendment request may not be required to fill out all sections. See below for specific amendment request scenarios:

  • if requesting a specific data file(s) for the first time under an existing DUA, fill out the Executive Summary section and Dissemination and Reporting of Findings sections only
  • if requesting only a change to your data management plan, fill out the contact information table on Page 1 and the Data Management Plan section only
  • if adding or making a change to the study objectives, please submit the original Executive Summary with the additions or changes noted. The addition or change should relate to the original study submitted. If not, a reuse request may be needed. 

CMS's Data Privacy Safeguard Program (DPSP)

See the Data Management Plan Guidelines and the Data Management Checklist Evaluation Guide below for details when preparing the data management section of the Executive Summary. Also, see an overview of the Data Privacy Safeguard Program and an FAQ document for more information on the program, both of which are provided in the list of additional resources below.

One-on-One Guidance Sessions

The Data Privacy Safeguard Program (DPSP) team that reviews your data management plan is available for One-on-One Guidance Sessions. The goal of these sessions is to answer any questions you may have about the information being requested in the data management plan. If your organization is interested in scheduling a One-on-One Guidance Session with representatives from the DPSP team, please contact the team at data_privacy_safeguard_program@mbltechnologies.com.

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