Census Data Request Form

CENSUS DATA REQUEST AND DATA USE AGREEMENT

Parties

Requester Name:   Organization:

Data Provider Name:   Provider Unit:

WHEREAS

Whereas Requester seeks access to certain aggregated and/or customized census-related data for legitimate research, planning, or administrative purposes to be described in the Scope of Work; and

Whereas Data Provider maintains custody of the requested datasets and requires reasonable assurances regarding use, confidentiality, compensation for services, and compliance with applicable data protection obligations; and

Now, therefore, in consideration of the mutual promises set forth herein, the parties agree to the terms and conditions of this Census Data Request and Data Use Agreement.

Scope of Work

Years requested: From to

Desired file format:   Delivery method:

Payment Terms

Total fee for services: $ (USD)

Late payment: If any undisputed amount is not paid within days of invoice, interest will accrue at % per month or the maximum permitted by law, whichever is less.

Term and Termination

Agreement term begins on and ends on unless earlier terminated in accordance with this section.

Either party may terminate for cause upon written notice if the other party materially breaches any obligation and fails to cure within days after receipt of written notice. Upon termination, Requester shall promptly return or securely destroy all non-public datasets and certify destruction if requested by Data Provider.

Confidentiality and Data Use Restrictions

Requester shall treat all non-public or restricted data as confidential, implement reasonable administrative, technical, and physical safeguards to prevent unauthorized access, and limit access to authorized personnel who have a documented need to know. Requester shall not attempt to identify, re-identify, or otherwise infer the identity of any individual or small group from aggregated or microdata, nor permit any third party access without prior written consent of Data Provider.

If Requester discovers a breach or unauthorized disclosure, Requester shall notify Data Provider promptly and cooperate in mitigation, notification, and remediation efforts. Requester agrees to indemnify Data Provider for losses resulting from Requester's negligent or willful failure to comply with confidentiality obligations.

By checking this box, Requester certifies agreement to the confidentiality and data use restrictions above and represents that it will implement the safeguards described.

Certifications and Assurances

Requester certifies that the data requested will be used solely for the stated purpose, that results will be reported in aggregated form that prevents disclosure of personally identifiable information, and that Requester will comply with all applicable statutes, regulations, and policies governing the use of the requested data.

Requester acknowledges that attempting to re-identify individuals or to publish disclosive cell sizes is prohibited and subject to penalties, including revocation of access and financial liability.

Liability, Indemnity, and Limitation of Remedies

Except to the extent arising from willful misconduct or gross negligence, neither party shall be liable for incidental, consequential, or punitive damages. Requester shall indemnify, defend, and hold harmless Data Provider from third-party claims arising out of Requester's misuse of the data or breach of this Agreement.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of without regard to conflict of law principles.

Entire Agreement

This Agreement, including any attachments or written amendments signed by both parties, constitutes the entire understanding between the parties with respect to the subject matter hereof and supersedes all prior proposals, negotiations, and agreements, whether written or oral.

Contact for Notices

Acknowledgement of Fees and Timeline

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