Document 85go0Kv495bqZBXjgYvXBdnva

DEPARTMENT OF HEALTH AND ENVIRONMENTAL SCIENCES VITAL RECORDS & HEALTH STATISTICS BUREAU STATE OF MONTANA' COGSWELL BUILDING 1400 BROADWAY PO BOX 200901 HELENA, MONTANA 59620-0901 Effective August 26, 1994 PROCEDURE AND POLICY REGARDING COPIES OF DEATH CERTIFICATES FOR RESEARCH PURPOSES Noncertified copies or partial copies of Montana death certificates may be provided to persons or organizations conducting public health, sociological, or epidemiological research. Such noncertified information will not be provided for legal, administrative, or other actions which may directly affect particular individuals or establishments as a result of their specific identification. Researchers must receive project approval before submitting names for which certificates are requested. Once approval is granted, a project number is assigned and the researcher may then submit a list of names, accompanied by the appropriate search fee. Procedure to obtain approval of the project: The researcher must submit a copy of the research protocol to the Bureau of Vital Records and Health Statistics. A completed Montana Department of Health and Environmental Sciences (MDHES) application form--and a completed National Death Index (NDI) application form where appropriate--must accompany the protocol. The protocol and/or accompanying forms must include the following: (a) a statement delineating the use to be made of the information on the certificate, as it relates to the research being conducted. (b) a statement assuring the Bureau that the researcher will preserve the confidentiality of the information obtained from the certificate and that the researcher will use the information for research purposes only. (c) the name, organization, address, telephone number and signature of the principal investigator for the research project. R&S151245 Birth/Death Certificates (406) 444-4228 Vital Records Administration (406) 444-3074 Tumor Registry (406) 444-2618 Health Statistics (406) 444-4261 FAX (406)444-1803 "AN EQUAL OPPORTUNITY EMPLOYER" Research Policy and Application Procedure Effective August 26 Page 2 (d) the name, organization, address, telephone number and signatures of an authorized representative of each additional first- and second-party organization having access to Montana death certificate copies or any identifying information taken from those copies. All such organizations will be bound by the Department's confidentiality and followback policies. (e) a statement delineating the disposition of the certificates upon completion of the research. The Bureau will make the approval/disapproval decision regarding the request, in most cases, within 10 working days of the date of receipt of the application and protocol. If the application is not approved, it will be returned to the requestor with the reason for such disapproval and any fee submitted will be refunded. Procedure to obtain copies for approved projects The request for copies of death certificates must reference the approved research project number (RPN). The accompanying list of names must include the following information: (1) decedent's full name (mandatory) (2) date of death or a three-year range to be searched (mandatory) (3) approximate age at death or date of birth (mandatory) (4) NDI file number (mandatory if name obtained from NDI) (5) sex of decedent (desirable) (6) place of death - city and/or county (desirable) Pricing and payment The search fee is ten dollars ($10.00) per name requested. The fee is payable in advance of the search, must accompany the list of names submitted, and is not refundable, except in the instance noted above. The Bureau reviews each certificate to be provided pribr to release to the researcher. If the Bureau's record search fails to produce a record that substantially matches that requested, the researcher will be so notified. The copies and search fee will be retained by MDHES. R&S151246 Research Policy and Application Procedure Effective August 26 Page 3 The researcher should submit the list of names and the search fee (check made payable to the Montana Department of Health and Environmental Sciences) to: Sam H. Sperry, Chief Vital Records and Health Statistics Bureau Department of Health and Environmental Sciences P.O. Box 200901 Helena, MT 59620-0901 Attn: Vital Statistics Research Telephone: FAX: (406) 444-4228 (406) 444-1803 The Bureau will make every effort to provide final copies within 15 working days following receipt of the list of names. Follow-back Researchers wishing to conduct follow-back investigations (i.e., contact any person named on the death certificate) based on information gathered from Montana death certificates must obtain special permission from the Bureau. Such permission should be requested at the time the protocol is submitted. Without this permission, the use of information contained in Montana death certificates as the basis for contacting persons or institutions is strictly prohibited. Researchers should not anticipate receiving such permission. Multiple"Research Projects and Research Application Renewal Research organizations must obtain individual approval for each project that requires the use of Montana death certificates. Researchers must notify the Bureau in writing whenever their research design changes substantially, there is a change in principal investigator, or they employ new second-party data acquisition or manipulation organizations on an approved project. Researchers must confirm their guarantee of confidentiality annually. For cases in which there has been no substantial change in the research project, researchers can meet this requirement by submitting a newly completed signature page, parts V and/or VI, of the Bureau7s VITAL RECORDS RESEARCH APPLICATION. Typically, the Bureau will include a request for this annual reaffirmation--when it is due--with its response to a death certificate request. R&S151247 f