Form 10074 (11/11) 10074 (11/11) PREDICT Dataset Proposal Submission

OMB # 1640-0012 / Expires XX/XX/XXXX

COVER LETTER
DATASET PROPOSAL SUBMISSION
Thank you for your interest in providing data to the PREDICT community. Questions regarding this
may be directed to PREDICT Legal Counsel, PREDICT Coordinating Center, via phone at +1 800 957
6422 (USA) or email, [email protected]
Please complete the information below and send an executed copy electronically to the PCC at
[email protected] or fax it to +1 866 835 0255, Attn: Project Manager. An executed copy will be
returned to you for your files.
Contact Information for Person Signing Document
Name
Title
Organization
Address
Address 2
City

State/Province

Postal Code

Country
Phone

Email
Alt Phone

Fax

Privacy Act Notice: DHS Authority to Collect This Information:  The Homeland Security Act of 2002 [Public Law 107‐296, §302(4)]. Principal Purpose:  DHS 
collects name, organization and title (if any), email address, home and/or work address, and telephone numbers for the purpose of contacting individuals 
regarding the PREDICT project and/or their involvement with PREDICT. Routine Uses and Sharing:  Some of your information will be disclosed to PREDICT 
team members, such as data hosts, data providers, PREDICT contractors, the PREDICT Coordination Center, the advisory board, and review board 
members to help us deliver requested PREDICT services and operate the PREDICT web site and deliver the services you have requested. Unless you 
consent otherwise, this information will not be used for any purpose other than those stated above. However, DHS may release this information of an 
individual on a case‐by‐case basis as described in the DHS/ALL‐002 System of Records Notice (SORN), which can be found at: www.dhs.gov/privacy. 
Disclosure:  Furnishing this information is entirely voluntary; however, failure to furnish at least the minimum information required to register (to include 
full name, email address,) will prevent you from obtaining authorization to access system. 
PRA Burden Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond to this information 
collection unless it displays a current valid OMB control number and an expiration date. The control number for this collection is xxxx‐xxxx and this form 
will expire on xx/xx/xxxx. The estimated average time to complete this form is 15 minutes per respondent. If you have any comments regarding the burden 
estimate you can write to Department of Homeland Security, Science and Technology Directorate, Washington, DC 20528 

DHS Form 10074(11/11)

1

Last Updated: 9-8-11_v1.1

DATASET PROPOSAL SUBMISSION

Please complete the following information regarding the dataset proposed for inclusion in the PREDICT repository and return it to
[email protected] or fax it to +1 866 835 0255, Attn: Project Manager.
Name
Title
Organization

Do you have a PREDICT Account?
Are you currently a PREDICT Researcher?
Are you currently a PREDICT Provider?

Address:

_____Yes
_____Yes
_____Yes

_____No
_____No
_____No

Email
Phone
Mobile

The following types of data are currently in the PREDICT repository or under consideration. Please indicate whether the dataset
you are proposing for PREDICT is within one of these categories by circling the most appropriate category. If none of these
categories is appropriate for your data, please enter a proposed category name.
See https://www.predict.org/ for a written description of most categories
Address Space Allocation Data
BGP Routing Data
IP Packet Headers
Blackhole Address Space Data
DNS Data
IDS & Firewall Data
Synthetic Data
Other:
Please provide a description of the dataset you are proposing:

Did your organization collect the data?
Date data was
collected
Are you willing to allow researchers
unrestricted access to the data?
Would you like to approve requests for
the data?

Yes

No

Infrastructure Data
Internet Topology Data
Traffic Flow Data
Unsolicited Bulk Email
VOIP Measurement Data
Web Logs
SONET Frame Data

Size of dataset (GB):

If no, who did?

Where was the data
collected?
_____Yes

_____No

_____Yes

_____No

What use restrictions would accompany the data (i.e. privacy no reversal of anonymization attribution etc.)?

DHS Form 10074(11/11)

2

Last Updated: 9-8-11_v1.1