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Medicare Data Use Agreement (DUA) Signature Addendum

Signature Addendum Examples:

A signature addendum is required when anyone not under the direct supervision of the requester or custodian handles the data. Listed below are some examples of when a signature addendum is required:

  • The requester has hired an outside company, that is not the custodian, to convert the tape cartridges.
  • The requester and custodian from the same department within a university are going to have the Information Systems department handle the tape conversion.
  • The requester and the custodian are collaborating with an investigator in another division or institution.

Signature Addendum Form

Signature Addendum Instructions