INSTRUCTIONS: Please submit an original-signature copy of this agreement. (It will be countersigned and a copy returned to you.) Use additional copies of this page if necessary.
The undersigned staff, in consideration of their use of restricted data from the National Survey of Alcohol, Drug, and Mental Health Problems [Healthcare for Communities], 1997-1998 certify the following:
1. That they have read the associated National Survey of Alcohol, Drug, and Mental Health Problems [Healthcare for Communities], 1997-1998 Restricted Data Use Agreement, and the Data Protection Plan incorporated by reference into this Agreement.
2. That they are "Research Staff" within the meaning of the Agreement (any research staff other than the Restricted Data Investigator).
3. That they will fully comply with the terms of the Agreement, including the Data Protection Plan incorporated by reference into it.
4. That they will not attempt to access National Survey of Alcohol, Drug, and Mental Health Problems [Healthcare for Communities], 1997-1998 restricted data until approved to do so by the ICPSR.
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Title/Formal Affiliation with Research Project |
Title/Formal Affiliation with Research Project |
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Signature |
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Typed Name |
Title/Formal Affiliation with Research Project |
Title/Formal Affiliation with Research Project |
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The above Research Staff are hereby granted approval to access National Survey of Alcohol, Drug, and Mental Health Problems [Healthcare for Communities], 1997-1998 restricted data:
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Inter-university Consortium for Political and Social Research
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Date
[General Information on HCC Restricted Data]
[Application for HCC Restricted Data]
[Data Protection Plan Instructions]
[Restricted Data Use Agreement]