Please complete the form below to request a Data Use Agreement. We will determine if an agreement is required and begin the process, if necessary.
All fields are required and you must click the Submit button at the bottom of this page. This form should only be completed by a member of the University’s workforce.
All fields with an * are required.
Is the data being provided or received?
Is the data covered under HIPAA? (Is the data Protected Health Information?)
Limited Data Set
Is any of the data originating in the EU?
Will any of the data be sent to or received in the EU?
Will any of the data be processed* in the EU?
*‘processing’ means any operation or set of operations which is performed on personal data or on sets of personal data, whether or not by automated means, such as collection, recording, organization, structuring, storage, adaptation or alteration, retrieval, consultation, use, disclosure by transmission, dissemination or otherwise making available, alignment or combination, restriction, erasure or destruction.
List or Upload Data Points:
Upload Data Points:
Please select one and explain.
Public Health Activities
Is the collection of data related to any sponsored research?
Has the Data Broker been contacted?
Has Research IT been contacted?
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