Please submit any DCDEE data request by completing the form below. You will be contacted within 3 business days of your request. Please email DCDEE.Data@dhhs.nc.gov if you have any questions.

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* 1. Please enter today's date.

Date

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* 2. Please select the category(ies) of the request.

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* 3. Requestor Name

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* 4. Requestor Title/Role

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* 5. Requestor Agency/Organization

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* 6. Requestor Email

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* 7. Requestor Phone

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* 8. What is the date by which you need the requested information?

Date
Describe your data request. Please include:

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* 9. The question(s) you are trying to answer

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* 10. The specific data elements you require including date range and geographical area needed

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* 11. The intended use of the data

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* 12. Will the data be shared publicly?

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* 13. Any additional information relevant for this request

Thank you for taking the time to complete the form.  Please review your answers and then click "Done".

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