SDSB Data Request Form

The National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) and DSTDP have made sexually transmitted infections (STI) data at the national, state, and county level publicly available on multiple websites. Please check these sources to determine if publicly available data meet your needs:

NCHHSTP AtlasPlus

DSTDP Annual STI Surveillance Report

*If the data on AtlasPlus and/or in DSTDP's annual STI Surveillance Reports don't fit your needs, please provide a justification for why publicly available data aren't sufficient:

In the event that publicly available data do not meet your data needs, please use the form below to specify the geographic level and disease(s) of interest for your data request. As you complete the form, information will populate detailing the interval of years available for each dataset, disease, and stratification by other related variables. Furthermore, it will alert you if the data of interest are already available on AtlasPlus.

Only if the data are not publicly available should you proceed with completing the remainder of this Data Request Form.

This form is designed to facilitate your request for data from the Division of STD Prevention's (DSTDP) Surveillance and Data Science Branch (SDSB). Please provide detailed information below about your data needs, including the specific data/sets you are interested in, the purpose of your request, and any relevant timelines. This will help us process your request efficiently and effectively.

Data security and confidentiality are very important to us, and all requests will be handled in accordance with our data protection policies. If you have any questions or need assistance while filling out this form, please do not hesitate to contact us.

*Name of requestor:

*Please enter your business email address:

*Job Title of Data Requestor:

Data Custodian (person responsible for receiving the data from CDC):

*Name:

*Business Email:

*Job Title:

Signatory official(s) (personnel with the authority to sign a data use agreement (DUA)):

*Name:

*Business Email:

*Job Title:

*Title of request:

Ex) Chlamydia and gonorrhea by county, state, age, and sex 1995-2021

*Name of Data Requestor's Organization
*Organization Type (check one)

Institution Address:

*Address
*City
*State
*Zip

Which type(s) of geographical data are you interested in? (Check all that apply)

What you need from us:

*Please provide the purpose and details of your request. Please keep in mind only aggregate data will be provided. At a minimum, the description should include:

Disease(s): chancroid, chlamydia, gonorrhea, P&S syphilis, early non-primary non-secondary syphilis, unknown/late syphilis, syphilis (all stages), congenital syphilis, total syphilis
Year(s)
Variables: e.g., age, sex, race/ethnicity
Geography: national, state, county

*When do you need it?

You can expect most data requests to be filled within 10 business days.

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