Project Evaluator Supporting Documents

Document K 

OMB No. 0930‐0286 

Expiration Date:  05/31/10 

GLS Cross-site Evaluation Data Access and Use Agreement
As the Suicide Prevention Data Center (SPDC) Site Administrator you have the highest level of privileges assigned to
the SPDC and that includes data download privileges. All data sets have been de-identified; however, to ensure the
highest level of rights protection for respondents represented in these data sets you are required to review and sign
this data access and use agreement. There are two fundamental aspects to this agreement, described below. The
first relates explicitly to SPDC access and use, and the second to data use and reporting.
I. SPDC Access: User IDs and Password
The purpose of this section of the agreement is to specify the conditions related to using the Suicide Prevention Data
Center as an assigned Site Administrator. The SPDC is the data management system that was developed to support
the Cross-site Evaluation of the Garrett Lee Smith Suicide Prevention Program sponsored by the Center for Mental
Health Services (CMHS) of the Substance Abuse and Mental Health Services Administration (SAMHSA).
Site Administrators of the SPDC are assigned the highest level of privilege to the system, including the ability to
assign other users and to download grantee-specific data. No other level of user access allows data download
capability. As an SPDC Site Administrator you are expected to adhere to the security standards of the SPDC to the
fullest, in respect to their interaction with other users and in handling suicide prevention information. As a user, you
are required to change the system-generated password to a self-generated password.
The undersigned gives the following assurances with respect to using the SPDC:

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You will not allow any other person to share your user ID and password and will accept responsibility for all
logins to the SPDC using your user ID and password.
You will not provide your user ID and/or password to any third party.
You will not leave the SPDC Web site unattended while logged on to the system.
If you believe any breach of security has occurred, such as the disclosure, theft, or unauthorized use of your
user ID and password, you will contact Macro International Inc. immediately.

II. Data Use
The purpose of this section of the agreement is to specify the conditions related to accessing/using the granteespecific Cross-site Evaluation data from the Garrett Lee Smith Suicide Prevention Program sponsored by CMHS.
The data sets should be used for the express purposes of local program monitoring, evaluation and sustainability. No
identifying information will be included in the grantee-specific data sets.
The undersigned gives the following assurances with respect to use of grantee-specific data:

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I must adhere to and be knowledgeable of relevant IRB regulations regarding the proposed use of the data.
In compliance with the Health Insurance Portability and Accountability Act (HIPAA) regulations, distributed
data will have all personal and identifying information removed from the dataset.
I will not use nor permit others to use cross-site evaluation data in any way except for aggregate statistical
reporting.
I will require others in the organization (specified below) who use the data to sign this agreement and will
keep those signed agreements on file and will submit copies of those signed agreements to SAMHSA upon
request.
I will not use, release nor permit others to release any information that identifies persons, directly or
indirectly.
I will not, nor will others, report aggregate information based on sample sizes fewer than 10.

Document K 

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Your Name:
Your Organization:

Expiration Date:  05/31/10 

I will not use or release nor permit others to use or release the data sets or any part of them to any person
who is not a member of the organization (specified below), except with the approval of SAMHSA and the
project officer for the grant programs under analysis.
I will not attempt to use nor permit others to use the cross-site evaluation data sets to learn the identity of
any person included in any set.
I will not contact nor permit others to contact establishments or persons in the data sets to question, verify,
or discuss data in the cross-site evaluation dataset.
I will make no statement nor permit others to make statements indicating or suggesting that interpretations
drawn analyses of these data are those of Macro International Inc. or SAMHSA.
I will acknowledge in all reports based on these data that the source of the data is the GLS cross-site
evaluation funded by the Center for Mental Health Services, Substance Abuse and Mental Health Services
Administration.

Both fields are required.

I Accept

OMB No. 0930‐0286