Section 2. Data Request Information Purpose of Request: Check One (“X”) Research Grant Evaluation Industry The purpose of this section is to provide a description of the project and the intended use of the requested data. Briefly describe your organization and your current role. Provide brief description of the data request. Please place an X next to Massachusetts and/or all applicable Massachusetts Counties from which you are requesting data. State/County Check County to Request Data Massachusetts Barnstable Berkshire Bristol Dukes Franklin Hampden Hampshire Middlesex Nantucket Norfolk Plymouth Suffolk Worcester Please describe the type of data you are requesting (i.e. Year, Drug Schedule). (County and state level data are categorized by age group, drug type, schedule, gender, and year.) Does the data request require Institutional Review Board (IRB) approval? (Y/N) [ ] If yes, please attach the IRB approval.
Section 2. Data Request Information Purpose of Request: Check One (“X”) Research Grant Evaluation Industry The purpose of this section is to provide a description of the project and the intended use of the requested data. Briefly describe your organization and your current role. Provide brief description of the data request. Please place an X next to Massachusetts and/or all applicable Massachusetts Counties from which you are requesting data. State/County Check County to Request Data Massachusetts Barnstable Berkshire Bristol Dukes Franklin Hampden Hampshire Middlesex Nantucket Norfolk Plymouth Suffolk Worcester Please describe the type of data you are requesting (i.e. Year, Drug Schedule). (County and state level data are categorized by age group, drug type, schedule, gender, and year.) Does the data request require Institutional Review Board (IRB) approval? (Y/N) [ ] If yes, please attach the IRB approval.
pmp-data-request-form.docx