Responsible Data Use Request Form

MCC Restricted Data Use Application

Documents and Forms

Document Name Document Type
Form EP-002 Responsible Data Use Request Form Form and Instruction
EP-002 Restricted Data User Request Form Restricted Data Use Request Form_Final.pdf Website is not yet live Form and Instruction
EP-002 Restricted Data User Request Form Restricted Data Use Request Form_Final.pdf Website is not yet live Form and Instruction
21-UFA04024-VDE RDUA_10-15-21_FINAL (1).pdf Restricted Data Use Agreement (RDUA) IC Document
21-UFA04024-VDE RDUA_10-15-21_FINAL (1).pdf Restricted Data Use Agreement (RDUA) IC Document

Information Collection (IC) Details

IC Title:	Responsible Data Use Request Form	Agency IC Tracking Number:	EP-001

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	EP-002	Restricted Data User Request Form	Restricted Data Use Request Form_Final.pdf	Website is not yet live	Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Restricted Data Use Agreement (RDUA)	21-UFA04024-VDE RDUA_10-15-21_FINAL (1).pdf	02/01/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.