SHS Data Use Request Form

INSTRUCTIONS

Please read the Data Confidentiality Rules then complete the form. Your signature on this form certifies that you will comply with the data confidentiality rules and that you will ensure any other data users on your team will also comply with the confidentiality rules.


Data requests requiring significant processing may be subject to a fee to recoup personnel time and expenses. You will be notified in advance of any fees that must be paid prior to processing the request.


Please email SHS.Ask@odhsoha.oregon.gov with questions.


CONTACT INFORMATION FOR DATA REQUEST


Are you requesting ACES data?*

Would you like to hear from a staff member from Maternal and Child health to provide technical assistance for analyzing ACES data?

Select the dataset(s) you are requesting

Note: Due to confidentiality, SHS and OHT public use datasets exclude identifiers below the county level (district ID and school ID and zip code), as well as height and weight variables (BMI is included in the dataset). Depending on the request, race, gender identity or sexual orientation variables may also be excluded from the dataset.

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GOALS OF DATA USE

(e.g., regional needs assessment, journal article, community report)

(e.g., 8th grade mental health, 11th grade e-cigarette smoking prevalence, PYD Benchmark)

Please describe any relevant details of your study. You can also attach documents below.


Typing my name and email below serves as my signature and certifies my agreement with the above.

Please add your program name to the end of the file name and upload the document.

Drag and drop files here or

Contact

Program Design and Evaluation Services

800 NE Oregon Street, Suite 260

Portland, OR 97232

Email: SHS.Ask@dhsoha.state.or.us