Report & Data Requests

Report & Data Requests

Allow 2 weeks on all Report & Data Requests

Person Making the Request*

Local Agency or Group*

Select

Requestor's Email*

Requster's Phone*

Phone

Data or Report Specifications & Elements*

Please use this space to state and explain the data and/or report desired. Be description and specific.

List the data values to be included in the end-product such as:

participant name
date of birth
participant category
WIC status
other demographics like address, phone number or email

IMPORTANT: a time frame for the data/report - are you looking for a snapshot view (today's values) or over a defined period like month, calendar year or federal fiscal year, etc.

Purpose & Use - Why is the data/report needed?*

Provide the reason for requesting and using the data or report. Detail what would be accomplished by obtaining the data/report.

Will the data or report be used for

clinic operations, internal use
outreach/retention to participants
presentation, internal or external audiences
grant application or reporting
other use, please provide detail

Intended Audience - Who or what entity is the data/report going to?*

Format of End Product*

Describe what is envisioned as the final format such as:

list in excel file
PDF file
Table or chart
Graph

When do you need the data or report?*

We are unable to provide data or ad-hoc reports upon demand or immediately, but we try to fulfill all requests as quickly as possible. Please be aware of the possibility that we could be unable to provide the data/report exactly as requested or that modifications or adjustments would be necessary for a partial or modified fulfillment.

Additional Information

Provide any additional context or information about your request, whatever you believe would be relevant or helpful. Such as...have you obtained the same data or report before? If so, when?

Request Date*

today's date / submission date for request

Thank You.

If you have questions or issues using this form, please contact the WIC Business Analyst (Alicia Guerra) at 402-471-2199 or alicia.l.guerra@nebraska.gov. THANKS!

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