Technical Assistance Request Form

Public health labs and agencies should complete this form if they are interested in receiving technical assistance (TA) from APHL or CDC to support their data exchange or informatics needs. Projects included within the scope of this TA request form include eCR, ELRTA, Cross Jurisdictional Data Exchange, DMI, and NNDSS.


* Use this form to submit a separate ticket for each discrete technical assistance request. You may submit multiple.*


If you are at a public health agency or lab and need access to Confluence to view linked resources below, please complete the Confluence Access Request form. Include “Access TA request form resources” in the Justification.




If after reviewing the above resources you are still unsure as to which project to direct this request, please email informatics.support@aphl.org.

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Please indicate the public health jurisdiction that is submitting this request

Are you submitting this request on behalf of the public health agency, the public health laboratory, or some other organization or entity?

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Name of person submitting request. This person will coordinate and manage communication related to this request. Please include first and last name.

Phone number of the person submitting this form

Email address of the person submitting this form

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Please indicate the type of technical assistance you're interested in receiving.

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The eCR project uses a separate request submission form. To complete this form, please click here.

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Provide a high-level summary of your technical assistance request. Please be as specific as possible about the systems that will be involved in this request. You may include attachments below, such as technical architecture diagrams, mapping documents, sample messages, etc.

Please provide a high-level summary of your technical assistance request. Be as specific as possible about the changes and/or additions. Include what format you are currently sending in HL7 messages through PHLIP.

What is your intended timeline to complete this request? Is other work/projects dependent on the completion of this request?

NOTE: If re-validation of the PHLIP feed is needed, it will take a minimum of 6 weeks depending on test suite size.

Have you talked to the other jurisdiction yet about establishing this connection? Who is your contact?

* Reminder to please submit a separate request for each InterPartner connection that you would like to establish. *

What transport mechanism do you currently use to support these use cases?

What type of transport mechanism do you want to implement?

What use cases do you intend to transition to this new transport mechanism?

If selecting "Other" please specify by typing in the box.

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Please indicate the Integration Engine(s) that you will be using to complete this project.

If needed, please explain how TA staff will be able to access your systems

If you're not sure which program best suits your TA needs, check out the links on the left. If you're still not sure, please enter details about your request here to initiate a ticket with the informatics.support@aphl.org.help desk.

Do you need assistance engaging or negotiating with your clinical partners to advance ETOR?

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Please upload any files, such as project plans, sample messages, lab workflows, technical architecture diagrams, etc., that will help APHL and CDC review your TA request.

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