0920-19BLE NCIPC DMP Template

ATTACHEMENT 2d: NCIPC DMP Template

Form Approved

OMB NO: 0920-xxxx

Exp. Date: X/XX/XXXX

NCIPC Data Management Plan Template

Project Identifiers and Description of Data

Project Title:
Principal Investigator Agency/Contact Information
Data Steward (if different from Principal Investigator)
Funding information (type and number)
Data Publisher/Owner
Last date DMP updated
Tags Tags (or keywords) to help users discover the data set; please include terms that would be used by technical and non-technical users.
Brief Description of project and data that will be collected. Include information on the public health impact. Human-readable description (e.g., an abstract) with sufficient detail to enable a user to quickly understand whether the data set is of interest.
Population Represented by Dataset: Describe population represented by the data, e.g. “residents of X”, “inpatients at X”, “users of product X”.
Location of Raw Dataset
Project Type □ Surveillance □ Research □ Evaluation □ Administration □ Other – Describe:
Type of data: □ Survey □ Record Review □ Observation □ Focus Group □ Other -- Describe:
Is data one-time data collection or ongoing □ One time □ Baseline and Follow-up (Specify expected number of follow-up collections: __________) □ Ongoing surveillance
Current project Status □ Planning, collection not started □ Collection ongoing □ Collection Complete – data cleaning □ Collection Complete – data available □ If data not yet available, Expected Data Release Date:
Temporal Metadata Start Date of data collection: End Date of data collection: (if ongoing indicate NA) If Ongoing: Are there scheduled releases □ Yes □ No If Yes, anticipated date of next release:
Spatial Metadata: as applicable include Country: Region: State: County: City:
Is there a Certificate of Confidentiality □ Yes □ No If Yes: Provide link
Security Assessment & Authorization Status (select one) ☐ Not started ☐ In progress with Information Systems Security ☐ Office of the Chief Information Security Officer processing ☐ Authority to Operate granted

Access to Data

Name of Dataset

Public Access level

The degree to which this dataset could be made publicly-available, regardless of whether it has been made publicly available

Check all that apply

☐ Public (Data set is or could be made publicly available to all without restrictions).

☐ Restricted access (Data set is available under certain use restrictions).

☐ Summary (Machine readable summary tables available),

☐ Non-public (Data set is not available to members of the public).

Justification of Access Level:

Information collected but not publicly available:

Data Dictionary

Location:

Format:

Other Dataset Documentation if available

Description:

Location:

If Restricted Data Set (Shared Data)

Data Use Agreement Required: ☐ Yes ☐ No

If available, link to Data Use Agreement:

Type of Use Agreement or License (select all that apply)

☐ Non-license / public domain

☐ Memorandum of Understanding

☐ Data Sharing Agreement

☐ Data Transfer Agreement

☐ Inter-Agency Agreement

☐ Other

Accessing Restricted Data

Data publisher/owner:

Website URL:

Download URL:

Data Standards (Optional Fields)

Data Plans and Protocols for Quality Assurance (links to SOPs or Descriptions of plans such as validations checks, quality assurance)

Process for Omitting Personally Identifying Information Prior to Public Release

Description of what identifiers are in the database, how they will be removed before data is published and by whom

Archival and Long-Term Preservation of Data

Preservation Timeline. State when and how the dataset will be archived or destroyed.