Data Management Plan - Questionnaire
This Questionnaire is not a standalone document, but part of the larger Data Management Plan ("DMP") requirement within the Data Use Agreement ("DUA") between the Data Recipient and the Maryland Department of Health. For other documents and information, please access our Data Request website at the following link: https://mmcp.health.maryland.gov/datarequests/Pages/default.aspx

This Questionnaire is to be completed upon request of Maryland Medicaid data. The Guidance Memo distributed along with this Questionnaire provides information explaining why a DMP is necessary, when the DMP comes into the data request process, and the minimum steps required for a sound DMP as part of the DUA to receive Maryland Medicaid data criteria for Data Management Plan to successfully obtain Maryland Medicaid Data. The Questionnaire uses "organization" as the generic term for the individual/corporation/research center requesting data, but data requests are not limited to organizations.
Email address *
Name and title of person filling out this form
Email and Phone Number of person filling out this form
Name of Organization
Date
MM
/
DD
/
YYYY
Next
Never submit passwords through Google Forms.
This form was created inside of Maryland.gov.