 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
 |
|
National Health Interview Survey Current Health Topic Public-use Data Files
Order FormDATA USE AGREEMENT - The Public Health Service Act (42 U.S.C. 242m(d)) provides that the data collected by the National Center for Health Statistics (NCHS) may be used only for the purpose for which they were obtained; any effort to determine the identity of any reported cases, or to use the information for any purpose other than for health statistical reporting and analysis, would violate this statutory restriction and the conditions of the data use agreement. NCHS does all it can to ensure that the identity of data subjects cannot be disclosed; as well as characteristics that might lead to identifications are omitted from the data set. Nevertheless, it may be possible in a rare instance, through complex analysis, and with outside information, to ascertain from the data sets the identity of particular persons or establishments.
Considerable harm could ensue if this were done.
Therefore, the undersigned gives the following assurances with respect to all NCHS data sets:
I will
not use nor permit others to use the data in these sets in anyway except for statistical
reporting and analysis;
I will
not release nor permit others to release the data sets to any person who is not a member
of this organization, except with the approval of NCHS;
I will
not attempt to link nor permit others to link the data set with individually identifiable
records from any other NCHS or non-NCHS data set;
I will
not attempt to use the data sets to learn the identity of any person or establishment
included in any set; and
If the
identity of any person or establishment should be discovered inadvertently, then (a) no
use will be made of this knowledge, (b) the Director of NCHS will be advised of the
incident, (c) the information that would identify an individual or establishment will be
safeguarded or destroyed as requested by NCHS, and (d) no one else will be informed of the
discovered identity.
My signature indicates my agreement to comply with the above-stated statutorily based requirements with the knowledge that deliberately making a false statement in any matter within the jurisdiction of any department or agency of the Federal Government violates 18 U.S.C. 1001 and is punishable by a fine of up to $10,000 or up to 5 years in prison.
Signed ____________________________________
Date ___________________________
Print or type name ____________________________________
Title ___________________________
Organization _____________________________________
Telephone (_____)________________
Data tape ordered
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
Proposed use
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
Density(BPI) : 6250 ____ Format: Tape ____ Cartridge ____ (Default is cartridge)
This form can be used for ordering data sets. Indicate the data sets you want, put your name and address below, enclose payment, and send to :
Division of Health Interview Statistics
National Center for Health Statistics
Center for Disease Control and Prevention
Presidential Building, Room 2217
3311 Toledo Road
Hyattsville, MD 20782
(301) 458-4001
Make check payable to:
U.S. Department of Health and Human
Services for Statistical Studies
Send indicated data sets to:
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
This page last reviewed January 11, 2007
|
