Extension of Agreement for Use of Restricted Data from DNORS
Please submit one original, signed electronic copy of this document,
which will be countersigned and returned to you.
AMENDMENT TO AGREEMENT FOR USE OF RESTRICTED DATA FROM
THE DISPLACED NEW ORLEANS RESIDENTS SURVEY
This Agreement is by and among RAND, a California corporation located at 1776 Main
Street, P.O. Box 2138, Santa Monica, CA 90407 (“RAND”) and the undersigned Restricted
Data Investigator, Center Director (if applicable), and Receiving Institution to protect against
potential misuse or disclosure of Restricted Data relating to RAND’s Displaced New Orleans
Residents Survey (“DNORS”).
This Agreement is hereby modified to extend the ending date of the Agreement, from the
original ending date of ______ to the new ending date of ______.
Name of Project:
____________________________________________________________________________
____________________________________________________________________________
All of the other terms and conditions of the Agreement remain in full effect, including, but not
limited to, the following:
1. The DNORS Restricted Data will be used solely for scientific and public policy statistical
research as described in the Research Plan submitted to and approved by RAND.
2. Access to Restricted Data will be limited solely to the Investigator who is signatory to this
agreement, with the exception that Investigator may allow use of Restricted Data by their
coinvestigators and research staff, provided these persons have signed a “Supplemental
Agreement with Research Staff” and work under the supervision of the Investigator.
3. The Research Plan and Restricted Data Protection Plan approved by RAND have been
reviewed and approved by the Receiving Institution’s Institutional Review Board/Human
Subjects Review Committee in accordance with the U.S. Federal Regulations under NIH
policy, and that Approval is currently certified and will remain certified for the duration of
this Agreement.
4. Restricted Data will be safeguarded in accordance with the Restricted Data Protection
Plan submitted to and approved by RAND; any violations will be reported to the Principal
Investigator and the appropriate IRB officials.
5. The Investigator will ensure that all originals and copies of Restricted Data, on whatever
media, will be either returned to RAND, or destroyed, at the end of this Agreement, or
within 5 days of a written demand from RAND; and the Investigator will certify to RAND
that this return/destruction has occurred.
6. Copies of any and all publications that result from use of the data will be submitted to
RAND.
Extension of DNORS Restricted Data Use Agreement Rev 6/2013
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RESTRICTED DATA INVESTIGATOR
__________________________________
Signature
Date
__________________________________
Name
__________________________________
Title
__________________________________
Telephone number
__________________________________
Institution
__________________________________
Fax number
__________________________________
Address
__________________________________
E-mail address
__________________________________
City
State
ZIP
FEDERALLY-FUNDED CENTER DIRECTOR
Required for Version 4 Restricted Data if the Restricted Data Investigator is not the PI of a
currently active federally-funded research grant or contract.
__________________________________
Signature
Date
__________________________________
Name
__________________________________
Title
__________________________________
Telephone number
__________________________________
Institution
__________________________________
Fax number
__________________________________
Address
__________________________________
E-mail address
__________________________________
City
State
ZIP
Extension of DNORS Restricted Data Use Agreement Rev 6/2013
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RECEIVING INSTITUTION
__________________________________
Signature
Date
__________________________________
Name
__________________________________
Title
__________________________________
Telephone number
__________________________________
Institution
__________________________________
Fax number
__________________________________
Address
__________________________________
E-mail address
__________________________________
City
State
ZIP
RAND
PROJECT LEADER
__________________________________
Signature
Date
__________________________________
Name
Displaced New Orleans Residents Survey
RAND Corporation
1776 Main Street, P.O. Box 2138
Santa Monica, CA 90407-2138
Tel: (310) 393-0411
INSTITUTION
__________________________________
Signature
Date
__________________________________
Name
Extension of DNORS Restricted Data Use Agreement Rev 6/2013
Contract and Grant Services
RAND Corporation
1176 Main Street, P.O. Box 2138
Santa Monica, CA 90407-2138
Tel: (310) 393-0411
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