Request for Data

The Division of Disease Surveillance (DDS) is the lead program in the collection, analysis, and interpretation of infectious disease surveillance data, specifically, notifiable diseases and/or conditions. Requests for data from external stakeholders are ongoing and the Request for Data form represents a process to monitor the nature and quality of requests. This form also provides an opportunity to critically review the type of data requests received and will engage the requestor to consider the need and justification for requesting the data.

This information will assist DDS to prepare and develop useful statistical reports and provide additional resources to external stakeholders for timely processing of all requests for public health infectious disease surveillance information.

Please complete the following with as much detail as possible. The information you provide will serve as the criteria for the Infectious Disease Epidemiology and Prevention Programs to respond to your data request. After receiving your request, it will be reviewed for feasibility. You will be contacted with any questions or concerns.

* indicates required fields

Individual and Organization Requestor Information

1. Contact Person (person requesting data)

2. Overall Responsible Party


Completion of the request will depend upon the complexity of the data search and/or data analysis.

for what years are you requesting analysis or information?

Note: it is sometimes necessary to combine data from multiple years to produce reliable statistics that do not conflict with confidentiality considerations. This is likely to be necessary for events that occur infrequently. Would your request still be useful if data from multiple years were grouped together?


what geographic area(s) are of interest (statewide, counties, one specific county, health service areas, city/town, etc.)?


Note: it may be impossible to release data at the town level, depending on the data set, the size of the city/town, and whether or not it would be acceptable to have multiple years of data combined, because of the need to maintain confidentiality.

describe as specifically as possible the information you would like to obtain. Be sure to indicate whether you are interested in an event that happened to Maine residents or are interested in events that occurred in Maine.

10. Format in which analysis should be sent: