Form 0920-25-0036 Data Request Application

OMB No. 0920-xxxx
Expiration Date xx/xx/xxxx
NOTICE - Public reporting burden of this collection of information is estimated to average
60 minutes per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB
control number. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to: CDC/ATSDR
Information Collection Review Office; 1600 Clifton Road, MS H21-8, Atlanta, GA 30333,
ATTN: PRA (0920-XXXX).

NCHS RESTRICTED VITAL STATISTICS DATA REQUEST APPLICATION FORM
Acknowledgement of Obligations
NCHS’ ability to grant access to vital statistics data is dependent upon meeting the conditions established by
the jurisdictions (50 states, 5 territories, DC, and NYC) that provide data to NCHS. Violation of the terms of
data use as specified on the NCHS website (https:// www.cdc.gov/nchs/nvss/nvss-restricted-data.htm) is
taken seriously and may result in, among other actions, no future access to any NCHS data. I/We understand
the following types of data requests are NOT appropriate (check all boxes to indicate agreement)
Requests that do not involve an evaluation of health or factors related to health.
Requests for data for only a single jurisdiction (Note: request for data for a single jurisdiction should be
directed to that jurisdiction’s vital records office: https://www.cdc.gov/nchs/w2w/index.htm).
Requests for geographic data below the levels described in the file descriptions.
Requests that require exact dates (month and year are available, exact day is not). See the data release
policy for details: https://www.cdc.gov/nchs/nvss/dvs_data_release.htm.
Requests for data files that would be sent, or accessed remotely from, outside the United States or its
territories, OR requests from overseas Principal Investigators who have no arrangement to be physically
in the U.S. and affiliated with a U.S. institution for the health-related research in question.
Requests that would link the data to other data sets in a manner that could allow
for the identification of individuals.
Requests that involve use of the data for commercial or resale purposes.
Requests that include plans to store data on portable storage unit and/or commercial cloud such as Dropbox,
Google Drive, Microsoft Azure, Amazon Web Services, etc.

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Instructions and Other Information
1. BEFORE completing the data application, please read the application completely and carefully review the
information for researchers available at: https://www.cdc.gov/nchs/nvss/nvss-restricted-data.htm.
2. ALL information on this application is required.
3. ONLY use the current electronic form edition.
4. DO NOT modify or alter the form.
5. INCLUDE all required and supporting documents as requested and submit your application
(PDF files ONLY).
6. Applications are reviewed in the order they are received. After review, you will receive notification of
approval, denial, or a request to re-submit the application with clarifications and/or amendments.
Applications are generally processed within 2 – 4 weeks.
7. You may contact the NCHS Research Review Team at nvssrestricteddata@cdc.gov with any questions
regarding the application process. If you are contacting the Team regarding an application already submitted,
please include the name of the Principal Investigator (PI) on the project application, the application title and
the number assigned by NCHS (if known).
8. After NCHS project approval, any questions regarding the status of file fulfillment, problems
accessing specific files or variables, changes to project personnel, and extended access to the same files
(with no new data years) should be directed to dvsdatarequests@cdc.gov.

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Project Title:
Section I: INVESTIGATOR AND INSTITUTIONAL INFORMATION
1. Principal Investigator
Title:

First Name:

MI:

Last Name:

Position:
Affiliation:
Phone:

Email address:
If Other, specify:

Organization Type (select one): Organization Type
If you select University (select a field): Field

if Other, specify:

Please attach CV’s, bio-sketches, or a brief summary of the qualifications for the principal investigators (include name
and contact details, current institutional affiliation, work experience, education, and publications) (PDF files only).
2. Student:
Is the PI a student?

Yes

No

If student, a letter of support from primary mentor or advisor is required (Please, upload a letter of support
printed on the letterhead of the institution and include: date, statement of support for the project/research,
professional relationship to the student, knowledge of student’s research qualifications, length of time
student has been under the mentor’s supervision, involvement of mentor in the project, and the name and
signature of the mentor or advisor) (PDF files only).
3. Primary Mentor or Advisor information:
Title:

First Name:

MI:

Last Name:

Position:
Affiliation:
Phone:

Email address:

Please attach CV’s, bio-sketches, or a brief summary of the qualifications for the primary mentor or advisor (include
name and contact details, current institutional affiliation, work experience, education, and publications) (PDF files only).

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4. Other Personnel: List all other personnel (up to 10) who will have access to the raw datasets (e.g., to view,
analyze, manage, secure).

a. Role:
Title:

First Name:

MI:

Last Name:

MI:

Last Name:

MI:

Last Name:

MI:

Last Name:

MI:

Last Name:

Position:
Affiliation:
Phone:

Email address:

b. Role:
Title:

First Name:

Position:
Affiliation:
Phone:

Email address:

c. Role:
Title:

First Name:

Position:
Affiliation:
Phone:

Email address:

d. Role:
Title:

First Name:

Position:
Affiliation:
Phone:

Email address:

e. Role:
Title:

First Name:

Position:
Affiliation:
Phone:

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f. Role:
Title:

First Name:

MI:

Last Name:

MI:

Last Name:

MI:

Last Name:

MI:

Last Name:

MI:

Last Name:

Position:
Affiliation:
Phone:

Email address:

g. Role:
Title:

First Name:

Position:
Affiliation:
Phone:

Email address:

h. Role:
Title:

First Name:

Position:
Affiliation:
Phone:

Email address:

i. Role:
Title:

First Name:

Position:
Affiliation:
Phone:

Email address:

j. Role:
Title:

First Name:

Position:
Affiliation:
Phone:

Email address:

Please attach CV’s, bio-sketches, or a brief summary of the qualifications for other personnel (include name and contact
details, current institutional affiliation, work experience, education, and publications) (PDF files only).

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Section II: TYPE OF APPLICATION
New Application OR

Previously Approved Application (Check all that apply)
Additional data years AND/OR

Amendment to data use

Section III: SPONSORING AGENCY & FUNDING INFORMATION
Is this project currently funded? ☐ Yes ☐ No

If Yes, sponsoring Agency:

Section IV: DATA SET INFORMATION:
1. Have you determined that the public use micro data files (https://www.cdc.gov/nchs/data_access/
vitalstatsonline.htm) or other publicly available data (e.g., https://wonder.cdc.gov/) cannot meet your
data needs?
☐ Yes

☐ No

2. Have you reviewed the data file descriptions/record layouts available at
https://www.cdc.gov/nchs/nvss/nvss-restricted-data.htm to make sure that the variables necessary for
your project are available?
☐ Yes

☐ No

3. Which vital statistics data files are you requesting? (Select all that apply)
NOTE: If you select the Natality-All Counties or Detailed Mortality-All Counties file, do NOT also select the
Natality-Limited Geography or Detailed Mortality-Limited Geography file; see the footnotes below. Request files
with county identifiers only if needed for county-level data aggregation or analyses. For years before 1989, the
public-use birth, death, and fetal files, available for download at
https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm, contain the geographic identifiers for all states and
counties.
Natality - Limited Geography1

Detailed Mortality – Limited Geography (2005+)2

Natality - All Counties3

Detailed Mortality - All Counties3

Fetal Deaths - All Counties4

Compressed Mortality - All Counties (not available after 2016)5

Period Linked Births/Infant Deaths - All Counties (not available after 2017)4
Period/Cohort Linked Birth/Infant Deaths - All Counties (2017/2016+)4

1

Birth-cohort Linked Births/Infant Deaths - All Counties (not available after 2015)4

Includes geographic identifiers for all states, plus counties and cities of 100,000 or more population.
for states only. Do NOT also select this if requesting files with county identifiers.
3Includes identifiers for all states, all counties, plus cities of 100,000 or more population.
4Includes identifiers for all states, all counties, plus cities of 250,000 population or more.
5Includes identifiers for all states and all counties, but only race, age group, sex, and underlying cause. Select either the Compressed
Mortality files or the more comprehensive Detailed Mortality-All Counties file, not both, unless there is a related research justification.

2Includes identifiers

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4. Years of Data Requested:
(Please see website, https://www.cdc.gov/nchs/nvss/dvs_data_release.htm, for our file-release time
frame.)
5. Was this specific study previously approved for different data years?
☐ Yes

No

If Yes, indicate for which data years, the date submitted, name of PI, and title of project.

6. Do you plan to link any other datasets to the data you are requesting?
Yes
No
If Yes, describe the other datasets and the type of data, data linkage, and/or level of data linkage (Do NOT link
with other data at the individual record level).

Section V: PROJECT SUMMARY
1. Please provide a brief overview of your project, including objective(s), study population (age, sex, race and
ethnicity, and geographic area and level), and analytical methods.

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2. State why the restricted rather than public-use vital events data are needed and how the requested data will
be used in the analysis.

3. Briefly describe the significance of the planned research and the purpose for which it will be used.

4. Please describe your plan for the release of results, including the public dissemination plans (for
example, presentations, publications, query systems, etc.).

5. Do you agree to abide by the NCHS data suppression standard that no count, including totals or rates based
on counts, should be less than 10 in tabulations, figures, graphs, maps, tables, etc. for sub-national geographic
areas, regardless of number of years combined? (Failure to abide by NCHS' data suppression standards will
result in loss of access to restricted use NCHS data. Deliberately making a false statement in any matter within
the jurisdiction of any department or agency of the Federal government violates 18 USC 1001 and is punishable
by a fine of up to $10,000 or up to 5 years in prison, or both).
☐ Yes

No

6. When do you expect to complete the proposed work? Provide justifications as needed.
(mm/dd/yyyy):
NOTE: The proposed project period may not exceed 2 years initially. To extend access to the same
data files past the approved period, you will need to apply to NCHS for an extension. To extend access
to the same files AND add new data years to the approved project, you will need to submit an
amended application.

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Section VI: SECURITY MEASURES
DVS restricted data may not be accessed outside of the U.S. and should be stored on, and accessed from, the
secure computer system of the affiliated organization or institution. If a secure computer system is not
available, the data may be stored on a password-protected, encrypted computer protected by anti-malware
and anti-virus software. Storage and access of data files using a portable storage or cloud-based system is
not permitted.
1. Where will the data be stored and accessed?
On my affiliated organization’s/institution’s computer system (i.e., not a commercial cloud server).
Note: The organization’s/institution’s computer must be used by student researchers.
On a stand-alone computer or laptop
_

Computer is fully encrypted and password protected
Computer is protected by (describe):

Other (describe):
2. Please clearly describe your institution’s data protection procedures, and if possible, state who will be
responsible for the security of the DVS restricted data. NOTE: If data stored at your (application PI’s) institution
will be accessed by project personnel at other institutions, clarify how access will be provided without
jeopardizing data security. Alternatively, if data will be stored at and accessed from more than one institution,
you must include a description of the data protection procedures and responsible party at EACH institution in
your response. Links to the institution's protection procedure documents are not acceptable. The description
needs to be sufficient to enable assessment of security of the system.

3. Additional information that may assist this review.

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