UPDATE REQUEST FORM

Please complete the following form and send it electronically to Elaine Yanisko at yaniskoe@imsweb.com .

Please mail a new DUA to the following address:

IMS, Inc.
Attn:  Elaine Yanisko
3901 Calverton Blvd.
Suite 200
Calverton, MD  20705

Please send any questions to yaniskoe@imsweb.com 

UPDATE REQUEST FORM

1.	PI name:

2.	Title of previously approved project:

3.	Research questions and methodology 

Has there been change in your research questions from your original proposal?

____ yes ____ no

If yes, please describe the changes:

4.	Data Storage  
Has there been change in where the data are stored?

____ yes ____ no

If yes, please describe the changes:

5.	Data Use Agreement:  Please download a new SEER-Medicare DUA and send a signed original version by surface mail to:

Elaine Yanisko
IMS, Inc.
3901 Calverton Blvd.
Suite 200
Calverton, MD  20705

Data Files Requested: Please check the SEER-Medicare data files you currently have and list the additional years of data requested. Note:  Medicare claims prior to 1998 are available only for cases diagnosed with cancer before 2003.   Cases diagnosed in 2003-2005 have claims from 1998+.  Cases diagnosed in 2006-2007 have claims from 2000+.  Cases diagnosed 2008-2009 will have claims from 2002+.

Name of file	Years available	Indicate which files and years you currently have	Additional years requested	
PEDSF (SEER cases)	1973-2009			
MEDPAR	1991-2010			
Outpatient	1991-2010			
Home Health (HHA)	1991-2010			
Hospice 	1991-2010			
NCH (physician/supplier)	1991-2010			
DME	1994-2010			
Part D Event (PDE)*	2007-2010			
SUMDENOM
5% non-cancer sample	1991-2009			
SUMDENOM
5% cancer sample	1991-2009			

The update of the PDE files may lag behind the rest of the linkage.

6.	Part D PDE data:  If you already have approval to receive the Part D PDE data, you do not have to complete this section.  Otherwise, you must describe below how these files will be used in your project.