Child Death Review Case Reporting System Data Use Agreement

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Attachment 2 A Request for the Release of CDR Case Report Data when Research Applicant Intends to Identify State(s) in Proposed Published Analysis or Results The following template will be used by NCRPCD to request written authorization from states participating with the CDR Case Reporting System for permission to release individual case report data to research applicants that intend to identify state jurisdiction in published analysis or results. State permission will be sought once the Data Dissemination Committee has approved the project. Dear State of (insert state) Data Holder: This letter is to inform you that the National Center for Review and Prevention of Child Deaths (NCRPCD) has received a request to release de -identified individual case report data. The request was submitted by (insert name of requestor and organization) on (insert date). The requester will be using the data for the purpose of (insert purpose). If the requester intends to use the data for a purpose other than what is stated here, they must submit a new request. Per the National Center for the Review and Prevention of Child Deaths' Guidelines for Requesting De -identified Dataset, written permission is necessary from each state where the research applicant intends to identify state jurisdictions in published or publicly released analysis or results of CDR data. As a reminder, de -identified individual case report data released by the NCRPCD will not include the list of data elements found in Appendix B of the NCRPCD Data Dissemination Policy and Guidelines. Please verify that your state is not precluded from releasing this data by any rules or statutes before signing this agreement. If you approve this data request, please sign both copies of the attached contract. Mail both copies to the National Center for Review and Prevention of Child Deaths for signature. 30