Checklist: Data Recipient Submitted Forms Submit completed checklist as part of Data Use Agreement submission. Document Completed & Attached Form Instructions Yes Data Use Agreement No, not applicable Yes Enter Recipient data output Attachment 1: Data Use No, not applicable to be provided to Lead Agreement Amendment Organization Yes Excel worksheet Attachment 2: List of Approved No, not applicable Data Elements Yes If Enclave product, specify Attachment 3: List of Authorized No, not applicable user(s) who will hold seat Data Users licenses; add emails Yes Exhibit A: Approved WA-APCD No, not applicable Data Application Yes Not applicable for Enclave Exhibit B: Approved Data No, not applicable product Management Plan Yes Exhibit B: Recipient Attestation of No, not applicable WA-APCD Rules and Policies Yes __ (Number of Agreements) Agreement is executed by Exhibit D: Recipient No, not applicable each Authorized Data User Confidentiality Agreement(s) Yes (Future Completion) Future completion Exhibit E: Certificate of Project No, not applicable Completion and Data Destruction Yes (Future Completion) Future completion Exhibit F: Certificate of Continued No, not applicable Need and Compliance Yes Exhibit G: WA-APCD Data Access No, not applicable Fee Yes Exhibit H: Recipient Data Output No, not applicable Yes Enclave product only Exhibit I: Analytic Enclave User No, not applicable Authentication Agreement Yes Enclave product only Exhibit J: Analytic Enclave Data No, not applicable Downloads Yes Other___________________ No, not applicable Yes Other____________________ No, not applicable
Checklist: Data Recipient Submitted Forms Submit completed checklist as part of Data Use Agreement submission. Document Completed & Attached Form Instructions Yes No, not applicable Data Use Agreement Yes No, not applicable Attachment 1: Data Use Agreement Amendment Enter Recipient data output to be provided to Lead Organization Yes No, not applicable Attachment 2: List of Approved Data Elements Excel worksheet Yes No, not applicable Attachment 3: List of Authorized Data Users If Enclave product, specify user(s) who will hold seat licenses; add emails Yes No, not applicable Exhibit A: Approved WA-APCD Data Application Yes No, not applicable Exhibit B: Approved Data Management Plan Not applicable for Enclave product Yes No, not applicable Exhibit B: Recipient Attestation of WA-APCD Rules and Policies Yes __ (Number of Agreements) No, not applicable Exhibit D: Recipient Confidentiality Agreement(s) Agreement is executed by each Authorized Data User Yes (Future Completion) No, not applicable Exhibit E: Certificate of Project Completion and Data Destruction Future completion Yes (Future Completion) No, not applicable Exhibit F: Certificate of Continued Need and Compliance Future completion Yes No, not applicable Exhibit G: WA-APCD Data Access Fee Yes No, not applicable Exhibit H: Recipient Data Output Yes No, not applicable Exhibit I: Analytic Enclave User Authentication Agreement Enclave product only Yes No, not applicable Exhibit J: Analytic Enclave Data Downloads Enclave product only Yes No, not applicable Other___________________ Yes No, not applicable Other____________________
Checklist_DUA%20Documents_Client_May%202018.docx