Data Set Request Form

Dataset Request Form

* = required field

Section A

Before filling out this form, you must obtain either an IRB Letter of Approval or Letter of Exemption. You will need to fill out either an Application for Research Review or Request for Exemption, both available on the Research Subjects Review Board (RSRB) web site. Once you have received your approval or exemption, enter the RSRB number in the appropriate box below.

In addition, you must provide a Human Subjects Protection Program (HSPP) number or an Ethical Principles in Research Program (EPRP) number.

Students who are requesting a dataset to be used exclusively for a class assignment are exempt from the RSRB requirements described above.

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*Data Set Title:
*Data Set Year(s):
*Purpose for data request:
*HSPP or EPRP Number: (Students: Enter "9999999" if you are requesting the dataset for a class assignment.)	HSPP EPRP
* Choose the appropriate type of clearance and enter the RSRB number. (Students: if you are requesting a dataset as part of a class assignment, choose "IRB Letter of Exemption" and enter "99999" as the RSRB number.)
*How do you want to get the data?	If choosing CD-ROM, please be sure to provide a mailing address in Section B.

Section B

*First Name:
*Last Name:
*E-Mail:
*Daytime Phone:
*UR Dept. or Affiliation:
Address/Box #:
*Status:

Section C

Other comments or things we should know about your request: