Data Deposit Form

Research Connections draws upon the expertise of ICPSR to manage the data collections that comprise its special topic archive. Data submitted to Research Connections are made available to researchers through both the Research Connections and ICPSR Web sites.

Please complete this form to provide ICPSR with information about the substantive and technical characteristics of your data collection. Completing the form ensures that your collections will be accurately and thoroughly described for potential secondary analysts in the social science community. It is vital that the information solicited on this form be provided as completely and accurately as possible.

The deposit form allows ICPSR staff to prepare a study description for the online searchable databases that ICPSR maintains as well as for various ICPSR printed publications. This information also permits the creation of authoritative bibliographic citations. Finally, the deposit form grants permission for ICPSR to archive and distribute your data collection. Please sign the form in the box below to attest to the four statements above the signature line.

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Please sign below. By signing, you give assurance of the following: I have implicit or explicit copyright to this work and have the right to make it publicly available through ICPSR. I give my permission for the Data Collection to be used by ICPSR for the following purposes, without limitation:

To redisseminate copies of the Data Collection in a variety of media formats To promote and advertise the Data Collection in any publicity (in any form) for ICPSR To describe, catalog, validate and document the Data Collection To store, translate, copy or re-format the Data Collection in any way to ensure its future preservation and

accessibility To incorporate metadata or documentation in the Data Collection into public access catalogues

I give my permission to ICPSR to enhance, transform and/or rearrange to the Data Collection, including the data and metadata, for any of the following purposes:

Protect respondent confidentiality Improve usability

To the extent allowable by law or permitted by the sponsor of the data collection, in preparing this data collection for public archiving and distribution, I have removed all information directly identifying the research subjects in these data, and I have used due diligence in preventing information in the collection from being used to disclose the identity of research subjects.

I further agree to release and hold harmless ICPSR (including staff and the ICPSR Council) and the University of Michigan from any and all liability from claims arising out of any legal action concerning identification of research subjects, breaches of confidentiality, or invasions of privacy by or on behalf of said subjects.

Printed name and title:

Institutional affiliation:

Signature : Date:

Research Connections •Inter-university Consortium for Political and Social ResearchP.O. Box 1248, Ann Arbor, MI 48106-1248

Phone: 734-615-7499 •Email: contact@researchconnections.org •Web site: www.researchconnections.org

I. Citation

a. Principal Investigator. For multiple investigators, list names in order they should appear:

b. Title. Provide a descriptive title of the data collection, including the time period(s) and geographic location(s) that the data cover:

c. Place of production (city/state) of data collection:

d. Date of production:

e. Organizational name of data producer:

f. Sponsoring or funding agency (if applicable):

g. Grant number(s) (if applicable):

h. Person/organization responsible for collecting data (if different from data producer):

i. Special collaborator(s) (if applicable):

Contact person for questions about the data collection during processing:

Name: ________________________________________________________________________________________

Email: ________________________________________________________________________________________

Phone: ________________________________________________________________________________________

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II. Description

Provide an abstract of the study. The abstract should describe the theoretical framework that informs the study, research questions addressed by the study, and any specific hypotheses tested.

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III. Methodology/Sampling

a. Describe the universe of the study:

b. Unit of analysis: (Check all that apply) individual household metropolitan area other

c. Mode of data collection: (Check all that apply) audio computer-assisted self interview (ACASI) coded video observation coded on-site observation cognitive assessment test computer-assisted personal interview (CAPI) computer-assisted self interview (CASI) computer-assisted telephone interview (CATI) face-to-face interview mail questionnaire mixed mode on-site questionnaire paper and pencil interview (PAPI) record abstracts self-enumerated questionnaire telephone interview web-based survey other

d. Type of data collection: (Check all that apply) census/enumeration data aggregate data clinical data event/transaction data survey data administrative records data program source code machine-readable text experimental data roll call voting data observational data other ___________________________________________

e. Time span covered by the data collection (months/days/years - include range(s) of dates):

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f. Date(s) the data were collected (provide specific dates and ranges, e.g., month/day/year-month/day/year):

g. Geographic area(s) to which data are relevant (e.g., New York City, Singapore, United States, Springfield, Ohio):

h. Smallest geographic unit represented in the data that can be analyzed:

i. Is the data collection one of a series? If so, provide a description of the series and its frequency or periodicity:

j. Describe the type of sample(s) obtained (e.g., random, convenience, snowball). If the sampling description is available in a printed publication, provide the complete citation.

k. Provide the response rate for each sample:

l. Describe the established measurement tools used in your study (e.g. MMPI, CPI, DSM-IV, CES-D, SF-36, Addiction Severity Index):

m. Is a complete sampling description of your data collection available? _____Yes _____No Location if you cannot supply it_______________________________________

n. Does your data collection contain weights? Please describe them in detail:

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IV. Update Existing Collection

a. If this is a new edition, extract, or special version of an existing ICPSR data collection, indicate the ICPSR study number and title of the existing collection and explain what has changed in the new version:

b. Should the old version continue to be made available? _____Yes _____No

V. Restrictions

a. Was there IRB Approval?

_____Yes _____No

b. May these data be made publicly available (e.g. download from the internet) without restrictions? _____Yes _____No

If no, list restrictions and explain the reasons for them:

c. If there is more than one file, can the data files be linked between files? _____Yes _____No

If the data files can be linked, specify the relationship between the files and the variables that link them:

Would linkage pose any risk of violation of confidentiality? _____Yes _____No

Can the data files be linked to other files not related to this data collection? _____Yes _____No

If the data files can be linked to an external data source, specify the relationship between the files and the variables that link them:

Would linkage pose any risk of violation of confidentiality? _____Yes

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_____No

VI. Description of Files

Here you may describe all files relevant to your deposit. Data - ICPSR prefers to receive data files in SPSS, SAS or Stata formats. Documentation - ICPSR prefers to receive electronic documentation in formats such as ASCII (text files)

or Microsoft Word. The original source document is preferred, but PDF files are acceptable. Please attach complete documentation below, such as:

Codebook: Specify the data position for each variable, the contents of each variable, provide full question text, and identify the range of possible codes and their meanings for each variable

Final project report, project summary, or other description of the project Data collection instrument(s). An electronic version of each instrument, if applicable, including

interview schedules, self-administered questionnaires, data collection forms for transcribing information from records, paper tests and scales, screening forms, and call-report forms should be included along with a description of the circumstances in which each was used (study populations, time periods, etc.)

Informed Consent Statement Bibliography of Related Literature - an electronic file listing all publications describing or

resulting from the data collection. Include the full title, full names of author(s), place of publication/publisher, journal name/volume/issue, full date, and page numbers, as applicable. Do not send literature reviews or other reference lists of publications that you may have used to help conceptualize your research. Send only lists of publications that you know are based on the data in this collection.

Summary statistics (frequency distributions, means, etc.) of all variables Other technical documentation, including the following: data dictionaries, sample consent

forms, codes used to create derived variables, interviewer and coder instructions, skip pattern instructions, user guide

a. Please list and describe all data files in the order they appear on your storage media. Under “format" indicate whether this is an ASCII file, a word processor file, a SAS Transport file, a SPSS Portable file, or a Stata file. ICPSR will not accept system files from any software package if they require a particular operation system.

File Name File Format Number Number Number of of Cases of Variables Records per Case

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_________________________________________________________________________________________________

2.

__________________________________________________________________________________________________

3.

__________________________________________________________________________________________________

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4.

__________________________________________________________________________________________________

5.

__________________________________________________________________________________________________

6.

__________________________________________________________________________________________________

7.

__________________________________________________________________________________________________

9.

__________________________________________________________________________________________________

10.

__________________________________________________________________________________________________

11.

__________________________________________________________________________________________________

12.

__________________________________________________________________________________________________

13.

__________________________________________________________________________________________________

14.

__________________________________________________________________________________________________

15.

__________________________________________________________________________________________________

16.

__________________________________________________________________________________________________

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Which of the following processing steps were performed on the data (mark with X)?

Consistency Checks Frequencies

Checks for Undocumented

Codes

Missing data codes

standardized File 1 File 2 File 3 File 4 File 5 File 6 File 7 File 8 File 9 File 10 File 11 File 12 File 13 File 14 File 15 File 16

Do the data contain blanks? _____ Do the data contain blanks nonnumeric codes? _____

Please summarize all documentation files submitted with your collection:_____Codebook/documentation _____SPSS Setup Files (“Data Definition Statements”)_____SAS Setup Files (“Data Definition Statements”) _____Stata Setup Files (“Data Definition Statements”)_____Database dictionary _____User Manual/Guide _____Data collection instruments (i.e., questionnaire)_____Other (please specify) ___________________________________________________

Research Connections is a partnership among the National Center for Children in Poverty at the Mailman School of Public Health, Columbia University; the Inter-university Consortium for Political and Social Research at the Institute for Social Research, University of Michigan; and the Child Care Bureau, at the Administration for Children and Families, U.S. Department of Health and Human Services. Research Connections promotes high quality research in child care and early education and the use of that research in policymaking.

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