Division of Child Welfare Data Request Form

This form will help gather information about the data being requested from the

Division of Child Welfare (Research, Analysis and Data Unit).

Media or Legislative Request

This submission is specific to a media or a legislative (Task Force/Bill/Amendment/Rule change) request

Media or Legislative Request

Have you checked for this information in CDHS Data Matters/Results Oriented Management Database (ROM)?

The CDHS Data Matters website is located here:

https://colorado.rom.socwel.ku.edu/reports

Today's Date

mm/dd/yyyy

Full Name of Requestor

Please provide your first and last name.

Are you from a county agency or CDHS?

Please Note:

Requests for personal records or records associated with specific cases cannot be fulfilled through this form.

To retrieve those types of records, please refer to the link below to find and contact the county in which the child/family received services.

https://cdhs.colorado.gov/contact-your-county

Request from Organization

If you selected "Not CDHS or County" from the previous question, please enter your organization name below.

Email Address

Phone Number

Example: xxx-xxx-xxxx

The Research, Analysis and Data Unit requires a

minimum of 2 weeks preparation time from making the report request to delivery of the report.

If you require data in less than the required two weeks, please describe the urgency for your request below, and indicate when you need the request to be completed. We cannot guarantee that your request will be completed by the date indicated, but we will do our best to meet your needs.

For any questions or concerns, please contact

Bobby Chen.

What is the desired completion date for your request?

What Area will the Data Examine/Topic

Please select what area the data will examine from the list below.

What is the time period you would like the data to reflect in the request?

Examples: June 1, 2011- October 31, 2011 or SFY 2016-17 or FFY 2016-17

Please provide any additional information:

What specific data fields do you want to see in the report?

Examples: county, client DOB, placement type

How do you want the data grouped?

Examples: By county or by month

Has this report been created previously by the Research, Analysis, Data Unit (RAD)?

Is this a recurring request?

Please indicate if this reqport will be needed more than once

Frequency

Will this report need to be provided daily, weekly, monthly, quarterly or annually, etc., please select from the list below.

What file format would you prefer to receive the results of this request?

Please feel free to upload previous examples, templates and/or screen shots here (PDF, Excel, Screen Shots).

Drop your files here

Send me a copy of my responses

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