I - Data Sharing Agreement

Attachment I: Data Sharing Agreement

DATA SHARING AGREEMENT

between

Agency for Toxic Substances and Disease Registry, National Toxic Substance Incidents Program (NTSIP) and

[insert name of person/agency],

I. AGENCIES PROVIDING AND RECEIVING DATA

AGENCY PROVIDING DATA: Agency for Toxic Substances and Disease Registry

CONTACT PERSON: Maureen F. Orr, M..S.

TITLE: Surveillance Team Lead/NTSIP Coordinator

ADDRESS: 4770 Buford HWY NE MS F-57

Atlanta, GA 30341

PHONE NUMBER: 770-488-3806

AGENCY RECEIVING DATA: _________________

CONTACT PERSON: _________________

TITLE: _________________

ADDRESS: _________________

_________________

II. PURPOSE OF AGREEMENT

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

III. DESCRIPTION OF DATA

[Insert what variables and subsets of data are necessary for the stated purpose]

IV. ACCESS TO DATA

A. METHOD OF ACCESS/TRANSFER:

The data will be provided by electronics transfer (e-mail) in a zipped, password protected file. If too large, a password protected CD will be mailed.

B. PERSONS HAVING ACCESS TO DATA:

Access to data shall be limited to ___________________________________________________________________.

The data recipient shall not release or disclose the data to third parties without written permission from the Agency for Toxic Substances and Disease Registry.

C. FREQUENCY OF DATA EXCHANGE

Data shall be delivered the date the agreement is signed. The agreement will terminate one year from date of signing.

D. OTHER PROVISIONS REGARDING DATA

The data can only be used for the described purpose. Other uses require prior written approval from the Agency for Toxic Substances and Disease Registry. All data will be returned to ATSDR at the end of the agreement.

5. CONFIDENTIALITY

The data provided will contain no company or individual identifiers. No attempts shall be made by recipient to determine company or individual identifiers. If identifiers are inadvertently discovered, the recipient shall notify the ATSDR data coordinator and secure that data so that it is not released. Recipient shall exercise reasonable precautions to secure said data from other individuals who are not authorized access to said data.

VI. RIGHTS IN DATA

Recipient agrees to provide copies of any research papers or reports prepared as a result of access to NTSIP under this Agreement, and to allow the Agency for Toxic Substances and Disease Registry to reprint or distribute same without charge, to the extent permitted under copyright protection laws and any applicable agreements as to copyright or related intellectual property rights.

Agency for Toxic Substances and Disease Registry, US Department of Health and Human Services will be cited as the source of the data in all tables, reports, presentations, and scientific papers. The data recipient’s organizations name should be cited as the source of interpretations, calculations, and/or manipulations of the data.

____________________________

Data Recipient

____________________________

Date

____________________________

ATSDR NTSIP Coordinator

__________________________

Date