111 North County Farm Road, Wheaton, Illinois 60187 www.dupagehealth.

org Procedure for Data Requests The DuPage County Health Department, Population Health Unit, provides data request services to partner agencies, universities, and the general public. In order to provide the highest quality of service in the most efficient, time-sensitive manner, please follow the data request procedure outlined below. All person/agencies requesting data or data analysis may do so by completing a Data Request Form and submitting it electronically to Peggy Iverson at piverson@dupagehealth.org. The Data Request Form must be filled out electronically using Microsoft Word. Sending the completed form by email is the preferred method for completing data requests. Instructions for completing the electronic Data Request Form Please complete the following fields accurately and with as much detail as possible: 1. Download the data request form. 2. Complete all fields in the form. 3. Date of Request: Fill in todays date (or the date the request is being made if different) 4. Date Data Needed: Fill in the date the data is needed. Note that data requests typically take 3-5 business days to complete. 5. Purpose/Use of the Data. Provide a brief description of why the data is needed and how the data will be used. 6. Type of Data Requested: Provide detailed information about the data that is being requested. In order to prevent delays, it is important to be specific when completing the Variables requested. Define the exact demographic group (i.e., age, race/ethnicity, gender, etc.) for which data is requested. 7. Geographic Area: Indicate the geographic area of interest (DuPage County, municipality, etc.). 8. Date Range: Indicate specific years, months, etc. 9. Save the document as an MSWord file. 10. Submit the request as an email attachment to:

To: Peggy Iverson, Population Health Analyst - piverson@dupagehealth.org

Subject: Data Request Form (applicant/agency name) Note:

111 North County Farm Road, Wheaton, Illinois 60187 www.dupagehealth.org You will be notified electronically, verifying receipt of the Data Request Form. As stated above, all data requests require at least 3 - 5 business days to process. Large or complex requests will require a longer timeframe for completion. Once you receive your completed data request, we ask that you properly cite the data with the source provided.

DATA REQUEST FORM Be as detailed as possible. Provide the date this request is needed. Please note: Data requests require 3- 5 business days to process. Name: Organization: Address: Contact number: Date of Request: Title: Contact email: Date Needed by:

Have you contacted additional DCHD staff regarding this request? Yes / No If so, who? Purpose/Use of data (briefly describe how data will be used):

Type of data requested (please provide a detailed description of the indicators/variables and/or analysis needed ):

Geographic Area (e.g., county, city, zip code, etc.): Date Range: Date Received: Data Provided: OFFICE USE ONLY (do not write in the spaces below): Date Sent:

111 North County Farm Road, Wheaton, Illinois 60187 www.dupagehealth.org

Data Source/Date Accessed:

Rev. 9/16/11

If you need assistance completing this form or have questions, please contact Peggy Iverson, Population Health Analyst at 630-221-7534 Submit completed forms via email: To: Peggy Iverson: piverson@dupagehealth.org Subject: Data Request Form