• This form is intended for those looking for health data and statistics about groups of people, not information specific to any one person or general information about health issues.
• Data will be released following Maine CDC's privacy policy
• Some requests for restricted data may have an associated fee, based on rules and statutes. If this is the case, you will be informed of the fee before the request is filled.
• Generally data requests will be filled in 10 business days. If a specific data request is likely to take longer, you will be informed of the anticipated time frame. If you need to data more urgently, please check our website for previously published data.
• You may be contacted for more information or clarification about your request.

If small numbers limit the availability of single year data, would it be acceptable to receive data that combines multiple years?

Yes No

* Data Elements Requested:

Please be as specific as possible.  For example:

• If you know the questions for a survey from which you are seeking data, please list those questions.
• If you want specific stratifications (such as by age, by gender or by other demographics) please indicate those here as well,  (e.g. “adolescent births, ages 15-17 by county” or Diabetes deaths by five-year age groups and gender by the State, include national comparison data”).

Please separate different data elements with semi-colons.

Date that the data is needed by:

*How do you plan to use this data?