1) |
Name: _____________________________________________________________________
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2) |
Institutional Affiliation: ________________________________________________________
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3) |
Project Title: ________________________________________________________________
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4) |
Phone Number: _________________________________________________________________
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5) |
E-mail Address: _____________________________________________________________
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6) |
Mailing Address: _____________________________________________________________
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7) |
Are you a U.S. citizen?
_____ Yes
_____ No
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8) |
Is your project related to a dissertation or other degree requirement?
_________________
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9) |
List the source(s) of funding (if any) for the project.
___________________________________________________________________________
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10) |
I have read the information on the AHRQ Data Center
provided on the MEPS Web site and understand that microdata used in
the analysis will not be released, and that release of summary data (tables, parameter
estimates) is dependent on a confidentiality review.
_____ Yes
_____ No
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11) |
What is your planned avenue for data access?
_____ In-person data access at the AHRQ Data Center in Rockville, MD
_____ In-person data access at a Federal Statistical Research Data Center (FSRDC).
_____ 90-day virtual data access through the MEPS-AWS SecureCloud. I understand that
this choice is subject to more restrictive limitations to data need requirements and
geographic data access is restricted to encrypted State FIPS codes and MSA indicators.
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12) |
List below the MEPS data file(s) and years to which you are requesting access.
_____ MEPS PUFs (Please specify file name and years, e.g., 2018-2020 MEPS Full-Year Consolidated Public Use Files):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
_____ MEPS-NHIS Link Files (Please specify years. Note that MEPS-NHIS Link Files are not available on AWS):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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13) |
Indicate below which MEPS-HC variables that are not available for public use to which you are
requesting access. To add other variables to this list, please include the instrument section and question number.
_____ State ID (encrypted if requesting AWS access)
_____ County ID (encrypted)
_____ Census Tract (encrypted)
_____ Census Block-Group (encrypted)
_____ ICD-9 or ICD-10 codes (please attach an Excel workbook listing
the specific diagnosis codes of interest)
_____ Other (please specify instrument section, question number, and description below):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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14) |
Are you requesting AHRF data?
_____ Yes (please attach an Excel workbook listing the names and descriptions of requested variables.)
_____ No
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15) |
If you are requesting State IDs, will you be producing state-level estimates?
_____ N/A
_____ No
_____ Yes (please describe the state-level estimates you intend to produce):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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16) |
If you have data that you want to merge with AHRQ data describe how and why
the merge is to be done in your research summary (item #21), and below describe the content
of the data to be merged. Also, attach documentation for each file to be merged, including
file layout, number of records, variable names and descriptive variable labels.
Data will not be merged unless the documentation is complete, including variable labels
and value labels. The merging of files requiring the use of identifying or potentially
identifying data will be conducted by our contractor. Complex merges may require the researcher
to enter into a task order agreement with the data processing contractor. A cost estimate will be provided
once the application is approved.
If merging State level data, there must be data for each State, and State identifiers
will be removed or encrypted after the merge is complete. The resulting data set will
be considered restricted, and its use limited to the AHRQ Data Center.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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17) |
Please provide an estimated time frame for completing your Data Center project
and how often you would like to have access to the Data Center, and with what frequency
(daily for two weeks, weekly for two months, etc). Please be aware that it can take four to six
weeks after your project has been approved to have your data files made available to you in
the Data Center.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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18) |
Please list your publication plans or other anticipated uses of
the data/research results.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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19) |
List below the persons other than yourself that will be working on
this project who may have access to the data.
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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20) |
Select below the software to which you need access in the Data Center:
_____ SAS
_____ STATA
_____ R (not available on AWS)
_____ Other (please specify below)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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21) |
Attach the following items:
- Cover letter addressed to the Manager of the AHRQ Data Center.
- Resume or Curriculum Vitae for all persons associated with the
project that will access the Data Center.
- For students, a letter from the department chair confirming
your student status and that the project is related to a degree
requirement.
- Abstract of the proposed research, not to exceed two pages.
- Summary of the proposed research, including the following:
- Description of why publicly available data are inadequate
- Explicit listing of all requested restricted variables and why they are needed.
- Full description of the output that you anticipate removing. Please be very specific
in describing your output needs, and specifically in how restricted-use data will be
displayed. Include detailed examples of all table shells, models, and/or graphs with
titles, and indicate the subsample and unit of analysis used in each type of table,
model, or graph.
- Applications including subnational geographic estimates (except Census Region/Division)
must include draft tables.
- Notice of IRB review.
- If merging researcher-supplied data, a letter from the data sponsor giving the AHRQ Data Center
permission to keep the data and to make it available to other Data Center users.
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I assert that the above and attached
information is, to the best of my knowledge, true and complete.
Name (print/type): _____________________________________________________
Date: _______________________________
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