CI Data Request Form

CI Data Request Form

Version 2

We need to gather some details from you to ensure a thorough review and timely completion of your request.

Please complete the form, as it contains the initial questions we will ask while scoping the assignment.

FEES

Before generating the data, the King County Regional Homelessness Authority will estimate the costs incurred in its preparation. Data requests that take two or fewer hours of total staff time to prepare will be free to the Requestor. For data requests that take more than two hours, staff time over the first two hours will be charged at $100/hour, with a 3-hour minimum. The two-hour time limit is per calendar year and is specific to the organization. Requestors from the same organization but who are clearly working on different projects will be treated as separate Requestors. Once the request is approved, a Data Use Agreement is executed, and payment is received, the data will be provided.

Human Services departments in local jurisdictions in Washington State, the Washington State Department of Social and Human Services, other King County government departments, and other public governmental agencies in King County will be exempt from fees to cover the costs of routine data requests. This includes internal requests from other DCHS divisions. However, this policy will apply to all other agencies and individuals.

Primary Contact Information

Name of Project*

Please provide a one-line description of your project

Are you making this request on behalf of KCRHA or is it for an outside organization?*

Is this request Internal / External to KCHRA?

Select or enter value

Primary Contact Name*

Primary Contact Email Address*

Department and/or Organization Name*

Please provide a brief but detailed description of the organization(s) that will be making use of this data.

Scope of Data Request

Is this a one-time request, or will this be part of a recurring deliverable?*

Select or enter value

Please provide a detailed description of request/project*

Please use the text box to describe in detail the nature of the request, including a breakdown by demographics and characteristics (such as Race/Ethnicity, Program Type, or Individuals or Households):

Please describe audience or stakeholders who will interact with this data?*

For example, community group, funder, internal program performance, public, etc.

For larger projects, such as data extractions, please describe the anticipated project timeline?*

If a DSA or IRB application/modification is necessary, please include it in your timeline.

Data Elements

Is this a "Time-Series" or a "Point-in-Time" data request?*

For example, are you interested in client or household enrollments from 2020 to the present? Or are you interested in individual enrollments on a specific night or day (Point-in-Time)?

Select

Does this data request include any of the following specific sub-populations?*

The following sub-populations have specific data considerations.

Select or enter value

Use below to describe other sub-populations included in this request?

Does this data request look at a specific part of the homelessness system?

Select all applicable programs/ parts of the homelessness management system that are relevant to your request.

Select

Does this data request include any Personally Identifying Information (PII)?*

Examples of PII include, but are not limited to Name, Birthdate, Gender ID, Social Security Numbers, and any combination of information that could be used to identify a Client.

Select

Data Sharing and Storing

Is this request being made on behalf of a Service Providing Organization within the King County/ Seattle Continuum of Care?*

For example, is this request part of a funded program evaluation on behalf of a program?

Select

Does the primary contact or Organization have a current Data Use Agreement on file with KCRHA for this request?*

Select or enter value

Prior Data Use Agreement Upload

Upload a signed and dated (current) Data Use Agreement or Request for Release of Information here. Any request that contains any level of Personal Identifiable Information (PII) will be rigorously reviewed for 'need-to-know', and in some cases, all or part of the request will be withheld until such time as 'need-to-know' criteria has been satisfied.

Drag and drop files here or

Describe where is the data will be stored/accessed?*

For de-identified or PII-containing data extractions or pulls, please describe below how you will store and access the data (including for how long).

What is the expected final format of the request?*

Please select the final output of file type you would like for this data request:

Select

What is the requested delivery date?*

Disclaimer: The actual delivery date will depend on the specifics of a request, current business priorities, and ongoing projects. Data requests require a minimum of two weeks from the request date for the request delivery date.

Thank You!

We review tickets on a weekly basis. Please allow a week for the team to review and assign.

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