Visiting Researche Visiting Researcher & CFOI Questionnaire

OMB No. 1220-0180

Bureau of Labor Statistics

Researcher Questionnaire

This questionnaire will assist the Bureau of Labor Statistics (BLS) in determining your eligibility to access restricted data and in completing the required paperwork if your project is approved. For multiple researchers applying together, but affiliated with different institutions, one questionnaire should be completed for each institution. Thank you for your cooperation.

Applicant Information (please attach a resume or CV)
Name:					☐ Dr. ☐ Mr. ☐ Ms.
Title:				Email:
Phone:				Fax:
Mailing Address:
Affiliation with Institution:
☐ Employee or faculty. If so, please specify: ☐ Full time ☐ Part time
☐ Student. If so, please specify your anticipated graduation date:
☐ Fellowship / Post-Doctoral Appointment. If so, please specify end date:
☐ Other. Please specify:
Institution Information
Institution Legal Name:
Identify Signing Official: This official must have the authority to enter into legal binding agreements on behalf of your employer or educational institution. For educational institutions, this official may be a President, Vice President, Provost, Director of Sponsored Research, Contracts Officer, or a similar official. Note that a Dean or Department Chair will not be accepted.
Name:					☐ Dr. ☐ Mr. ☐ Ms.
Title:				Email:
Phone:				Fax:
Mailing Address:

Project Information

Title:

BLS Data Set(s):

Years of BLS Data:

Non-BLS Data Set(s):

Note that linking to outside datasets is not permitted for Offsite CFOI Virtual Data Enclave (VDE) data.

Outside Software:

Research presentation methods

☐ Journal Articles(s) ☐ Dissertation(s) ☐ Conference(s) ☐ Government Report ☐ Other, please specify:

Requested Access Location: (choose one)

☐ BLS Office in Washington, DC ☐ FSRDC: __________________________________________________ Please verify on the BLS website (https://www.bls.gov/rda/home.htm ) that desired data is available for use at the specified FSRDC ☐ Offsite CFOI Virtual Data Enclave (VDE) Specify all addresses in Section 8 where researchers will physically access data in the VDE. Institution locations only, access from residential facilities is prohibited.

Description of your approach to completing the project within a two-year time period. (For example, you may plan to do your research all at once, or you may plan to work periodically a week at a time. Also, please detail any special circumstances that may affect your availability to access data. Examples of include: grants, visiting professorships, fellowships, and sabbaticals.)

Sources of Funding

What are the sources of funding (if any) for this project?

Collaboration

Are you collaborating with any other universities or institutions for this project?

☐ Yes

☐ No

If yes

What university/institution(s)?

Please list the names of the collaborators.

Specify if any of those collaborators need access restricted microdata.

Recipient Project Coordinator

Recipient Project Coordinator: A project coordinator must be an employee of the institution and serves as the main point-of-contact between the BLS and the institution. An applicant may serve as project coordinator unless the applicant is a student.

Check if same as applicant.

☐

If not the same as applicant, please fill out the following information:

Name:

☐ Dr. ☐ Mr. ☐ Ms.

Title:

Email:

Phone:

Fax:

Mailing Address:

Affiliation with Institution:

☐ Full-time employee or faculty

☐ Part-time employee or faculty

☐ Other. Please specify:

Will the recipient project coordinator require access to the restricted data?

☐ Yes

☐ No

If yes, please provide their resume or CV.

Additional Individuals Seeking Access to Restricted Microdata

Please specify any additional individuals from your institution who require access to restricted microdata. (For example, student research assistants). Attach a resume or CV for each individual.

1

Name:

☐ Dr. ☐ Mr. ☐ Ms.

Title:

Email:

Affiliation with Institution:

☐ Employee or faculty. If so, please specify: ☐ Full time ☐ Part time

☐ Student. If so, please specify your anticipated graduation date:

☐ Fellowship / Post-Doctoral Appointment. If so, please specify end date:

☐ Other. Please specify:

Name:

☐ Dr. ☐ Mr. ☐ Ms.

Title:

Email:

Affiliation with Institution:

☐ Employee or faculty. If so, please specify: ☐ Full time ☐ Part time

☐ Student. If so, please specify your anticipated graduation date:

☐ Fellowship / Post-Doctoral Appointment. If so, please specify end date:

☐ Other. Please specify:

Name:

☐ Dr. ☐ Mr. ☐ Ms.

Title:

Email:

Affiliation with Institution:

☐ Employee or faculty. If so, please specify: ☐ Full time ☐ Part time

☐ Student. If so, please specify your anticipated graduation date:

☐ Fellowship / Post-Doctoral Appointment. If so, please specify end date:

☐ Other. Please specify:

For Offsite CFOI VDE access only, please specify the location where each researcher will access the VDE (All work must be performed on the institutions’ premises, not including dorms or other residential facilities)
1	Name:		Email:
	Room number & building name:
		☐ Office ☐ Cubicle ☐ Computer lab
	Smartphone Device Type (You will be assigned an RSA software token to turn your smartphone device into a two-factor authentication device to log into your Data Enclave account.)			☐ iPhone ☐ Android ☐ Other, please specify:
	☐ SAS ☐ Stata ☐ R ☐ RStudio ☐ Stat/Transfer ☐ SPSS ☐ Python (Spyder, Jupyter Notebook)
1	Name:		Email:
	Room number & building name:
		☐ Office ☐ Cubicle ☐ Computer lab
	Smartphone Device Type (You will be assigned an RSA software token to turn your smartphone device into a two-factor authentication device to log into your Data Enclave account.)			☐ iPhone ☐ Android ☐ Other, please specify:
	☐ SAS ☐ Stata ☐ R ☐ RStudio ☐ Stat/Transfer ☐ SPSS ☐ Python (Spyder, Jupyter Notebook)
1	Name:		Email:
	Room number & building name:
		☐ Office ☐ Cubicle ☐ Computer lab
	Smartphone Device Type (You will be assigned an RSA software token to turn your smartphone device into a two-factor authentication device to log into your Data Enclave account.)			☐ iPhone ☐ Android ☐ Other, please specify:
	☐ SAS ☐ Stata ☐ R ☐ RStudio ☐ Stat/Transfer ☐ SPSS ☐ Python (Spyder, Jupyter Notebook)
1	Name:		Email:
	Room number & building name:
		☐ Office ☐ Cubicle ☐ Computer lab
	Smartphone Device Type (You will be assigned an RSA software token to turn your smartphone device into a two-factor authentication device to log into your Data Enclave account.)			☐ iPhone ☐ Android ☐ Other, please specify:
	☐ SAS ☐ Stata ☐ R ☐ RStudio ☐ Stat/Transfer ☐ SPSS ☐ Python (Spyder, Jupyter Notebook)
1	Name:		Email:
	Room number & building name:
		☐ Office ☐ Cubicle ☐ Computer lab
	Smartphone Device Type (You will be assigned an RSA software token to turn your smartphone device into a two-factor authentication device to log into your Data Enclave account.)			☐ iPhone ☐ Android ☐ Other, please specify:
	☐ SAS ☐ Stata ☐ R ☐ RStudio ☐ Stat/Transfer ☐ SPSS ☐ Python (Spyder, Jupyter Notebook)

For Offsite CFOI VDE access only: Import Coordinator
Identify the member of the research team who will upload the imports of external datasets:

Privacy Act Statement. The information you provide will be used by staff at the Bureau of Labor Statistics (BLS) to determine your eligibility for access to restricted BLS data and for other administrative purposes. In accordance with the Privacy Act of 1974 as amended (5 U.S.C. 552a), details about routine uses can be found in the system of records notice,  DOL/BLS – 21, Data Sharing Agreements Database (81 FR 47418).  Providing the information on this form is voluntary; however, the BLS will not be able to grant access to restricted BLS data without this information. The information provided will be used to draft agreements with your institution, which upon full execution are public records. The BLS is authorized to request the information on this form under Title 5, United States Code, Section 301.

Paperwork Reduction Act Statement. This information is being collected to allow access to restricted information on a limited basis to eligible researchers for approved statistical analysis. We estimate that it will take an average of 30 minutes to complete this form. The responses to this collection of information are voluntary. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the U.S. Department of Labor, Bureau of Labor Statistics, Division of Management Systems, Attention: BLS Clearance Coordinator, 2 Massachusetts Ave., NE, Room 4080, Washington, DC 20212.