Att 4 Data Management Ack

Attachment 4

DATA MANAGEMENT ACKNOWLEDGEMENT

Formative Research and Tool Development

Assurance of Data Security

The Centers for Disease Control and Prevention (CDC) and RTI International (RTI) has assured each interview participant that the privacy of their responses will be maintained by RTI and that no information obtained in the course of this activity will be disclosed in a manner in which a participant is identifiable.

Agreement

I, [INSERT NAME] have carefully read and understand the Data Management Acknowledgement that pertains to the secure nature of all data to be handled in regard to this project. As a consultant to RTI International/CDC contractor working on this project (circle one), I pledge that I will not disclose any information or findings obtained under the terms of this agreement to anyone other than authorized project staff of the CDC or RTI.

I further understand and agree to comply with the following provisions:

1. Any materials that would permit the identification of participants are to be treated as private.

2. Data obtained from the interviews, whether identifiable to a participant or not, may not be released to any person or party outside of RTI or CDC. This includes but is not limited to survey data and or qualitative data from the participant’s comments and discussions. Exceptions will only be made with prior written approval from CDC and RTI.

3. No data, tabulations or analyses obtained under this contract may be released or used without prior written approval of CDC and RTI International.

4. Any breach must be reported immediately to the RTI project director, Jennifer Uhrig at 1-800-334-8571, extension 3311 and the CDC technical monitor, Donata Green, at 404-639-3869.

_________________________________

Name (Print)

_________________________________

Signature