CERTIFICATION OF DATA DISPOSITION. Date of Disposition All copies of any Datasets related to agreement DOH# have been deleted from all data storage systems. These data storage systems continue to be used for the storage of confidential data and are physically and logically secured to prevent any future access to stored information. Before transfer or surplus, all data will be eradicated from these data storage systems to effectively prevent any future access to previously stored information. All copies of any Datasets related to agreement DOH# have been eradicated from all data storage systems to effectively prevent any future access to the previously stored information. All materials and computer media containing any data related to agreement DOH # have been physically destroyed to prevent any future use of the materials and media. All paper copies of the information related to agreement DOH # have been destroyed on-site by cross cut shredding. All copies of any Datasets related to agreement DOH # that have not been disposed of in a manner described above, have been returned to DOH. Other The data recipient hereby certifies, by signature below, that the data disposition requirements as provided in agreement DOH # , Section C, item B Disposition of Information, have been fulfilled as indicated above. Signature of data recipient Date APPENDIX D DOH SMALL NUMBERS GUIDELINES • Aggregate data so that the need for suppression is minimal. Suppress all non-zero counts which are less than ten. • Suppress rates or proportions derived from those suppressed counts. • Assure that suppressed cells cannot be recalculated through subtraction, by using secondary suppression as necessary. Survey data from surveys in which 80% or more of the eligible population is surveyed should be treated as non-survey data. • When a survey includes less than 80% of the eligible population, and the respondents are unequally weighted, so that cell sample sizes cannot be directly calculated from the weighted survey estimates, then there is no suppression requirement for the weighted survey estimates. • When a survey includes less than 80% of the eligible population, but the respondents are equally weighted, then survey estimates based on fewer than 10 respondents should be “top-coded” (estimates of less than 5% or greater than 95% should be presented as 0-5% or 95-100%).
CERTIFICATION OF DATA DISPOSITION. Date of Disposition All copies of any Datasets related to agreement DOH #Nxxxxx have been deleted from all data storage systems. These data storage systems continue to be used for the storage of confidential data and are physically and logically secured to prevent any future access to stored information. Before transfer or surplus, all data will be eradicated from these data storage systems to effectively prevent any future access to previously stored information. All copies of any Datasets related to agreement DOH #Nxxxxx have been eradicated from all data storage systems to effectively prevent any future access to the previously stored information. All materials and computer media containing any data related to agreement DOH #N22584 have been physically destroyed to prevent any future use of the materials and media. All paper copies of the information related to agreement DOH #Nxxxxx have been destroyed on-site by cross cut shredding. All copies of any Datasets related to agreement DOH #Nxxxxx that have not been disposed of in a manner described above, have been returned to DOH. Other The data recipient hereby certifies, by signature below, that the data disposition requirements as provided in agreement DOH #Nxxxxx, Section C, item B Disposition of Information, have been fulfilled as indicated above.
CERTIFICATION OF DATA DISPOSITION. Date of Disposition: Select date Check all that apply: All copies of any datasets related to Agreement DOH#_______ have been destroyed from all data storage systems currently under or previously under control of the Information Recipient identified in Agreement DOH#______ to effectively prevent any future access to the previously stored information. All materials and media currently under or previously under control of the Information Recipient identified in Agreement DOH#______ containing any data related to Agreement DOH #_______ have been physically destroyed to prevent any future use of the materials and media. All paper copies of the information currently under or previously under control of the Information Recipient identified in Agreement DOH#______ related to agreement DOH#_______ have been destroyed on-site by cross cut shredding. Other (provide details in an attachment to this document). The Information Recipient hereby certifies, by signature below, that the data disposition requirements as provided in Agreement DOH # _________, Section C, item B Disposition of Information, have been fulfilled as indicated above. The person signing below indicated, by signing, that they have the authority to sign on behalf of the Information Recipient, if the Information Recipient is an organization. Sign here Select date Signature of Information Recipient Date Sign here Print Name APPENDIX D
