Office of Juvenile Affairs - Data Request Form
Time Elapsed:
0
minutes
Time Remaining:
0
minutes
Total Time:
0
minutes
Anonymous Login Code:
Code Entry Page
Save this code which is required to update your response at a later time.
Page 1 of 1
Contact Information
1.
Organization Name:
*
2.
Requestor Name:
*
3.
Type of Requestor:
*
--Please Select--
State Government
Federal Government
Private Organization (non-media)
News Media
University/Educational
Law Enforcement
Attorney
Other
4.
Address / City / State / Zipcode:
*
5.
Phone:
*
6.
Email Address:
*
7.
OJA User Sponsor / Department supporting this request:
Information About your request
8.
Has this request been previously completed?
*
--Please Select--
Yes
No
9.
Who will have access to this data?
10.
Will this data be released publicly?
--None--
Yes
No
11.
Suggested delivery date:
*
12.
Is there a need for recurrence?
*
--Please Select--
None
Weekly
Monthly
Quarterly
Annually
13.
Please provide the specific purpose for your request to help us determine the most appropriate data to send you. In addition, please provide how the data will be used.
14.
Please provide a detailed description of the data request, including any selection criteria. (examples: referrals, placement information, legal status, etc.)
15.
Are you requesting restricted/confidential data (client specific)?
*
--Please Select--
Yes
No
16.
What date period do you need?
*
--Please Select--
State Fiscal year (July -> June)
Calendar year (Jan -> Dec)
Federal Fiscal year (Oct -> Sept)
Other
17.
Data Begin Date:
*
18.
Data End Date:
<p>Your browser does not support iframes.</p>