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Minnesota BRFSS Data Request and User Agreement Form

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The purpose of this form is to request access to Minnesota Behavioral Risk Factor Surveillance System (BRFSS) survey data. The Minnesota BRFSS is conducted under a cooperative agreement between the Minnesota Department of Health (MDH) and the Centers for Disease Control and Prevention (CDC). The dataset that will be provided contains CDC core and optional module variables (identical to those available from the CDC website) as well as additional state-added variables that are not available from the CDC. Investigators will also receive a codebook describing the contents of the dataset(s).

For any questions about the data or help with completing this form, please contact the Minnesota BRFSS coordinator, Mark Lee (mark.lee@state.mn.us).

Name of Principal Investigator

* must provide value

Agency/Institution

* must provide value

Phone

* must provide value

E-mail

* must provide value

Year(s) of data requested

* must provide value

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

2021

2022

Data file type requested

SAS (.sas7bdat)

SAS Transport (.xpt)

SPSS (.sav)

Stata (.dta)

CSV (.csv)

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By checking the box below, the investigator agrees to the following:

I will not provide the Minnesota BRFSS dataset(s) to another party. I will not allow others outside my agency/institution to have access to the dataset as a discrete entity in any manner including via the electronic web. If other parties request this BRFSS dataset, I agree to refer the parties to the Minnesota Department of Health. Any third party is subject to the requirement of submitting a data request and user agreement to the Minnesota Department of Health.
Minnesota BRFSS data will not be used to identify or attempt to identify a person.
The Minnesota BRFSS dataset will be maintained in a secure file that is only accessible by the person(s) named above who is/are responsible for carrying out the agreement or those who work under the supervision of the person named above.
Research will be conducted according to accepted procedures as specified in the current BRFSS data user guide (available for download below) and with integrity.
- Complex-Sampling-Weights-and-Preparing-Module-Data-for-Analysis-2022-508.pdf
The Minnesota BRFSS coordinator will be provided with a written or electronic copy of any products, publications, articles, or media releases that contain analysis of the Minnesota BRFSS dataset. This is not for the purposes of approval of the material, but rather so MDH staff can learn of the latest findings obtained through analysis of the Minnesota BRFSS survey and can be prepared for subsequent related questions, should any arise.

I agree to the conditions listed above.

* must provide value

Yes

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.