OMB #: 0970-0531
Expiration Date: 09/30/2025
ACF Optional-Use Data Sharing Request Form
To be completed by ACF (select one): ☐
Approved ☐
Denied ☐
Returned for Modification
Instructions: Fill out the information below and then provide thorough responses to the questions as appropriate to your request.
Primary Contact Name: ____________________________________________________________
Primary Contact Job Title: __________________________________________________________
Organization or Institution Name: ___________________________________________________
Organization or Institution Address: _________________________________________________
(Provide street address, city, state, zip code)
Primary Contact Phone Number: ____________________________________________________
Primary Contact Email Address: _____________________________________________________
Project Title: ____________________________________________________________________
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PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to facilitate processing of requests for access to ACF Program Office data for research and statistical purposes and to help ACF better understand data sharing requests in aggregate. Public reporting burden for this collection of information is estimated to average 180 minutes per individual, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing and completing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. All information collected will be kept private to the extent permitted by law. If you have general comments on this collection of information, please contact the ACF Office of Planning, Research and Evaluation, Division of Data and Improvement by email at [email protected]. If you have specific questions regarding your data sharing request being made under this form, please contact the ACF Program Office from which you are seeking data.
1 Affiliation with a Federal Statistical Research Data Center or Special Sworn Status are not required. This question is intended to help us ascertain whether someone has previously gone through the process of being approved to use restricted-use data.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Williams, Joshua (ACF) |
File Modified | 0000-00-00 |
File Created | 2024-07-20 |