Fillable Federal Researcher Questionnaire 2014 (Bureau of Labor Statistics)

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Federal Researcher Questionnaire 2014 (Bureau of Labor Statistics)

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The Federal Researcher Questionnaire 2014 (Bureau of Labor Statistics) form is 3 pages long and contains:

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Bureau of Labor Statistics
Federal Visiting Researcher Questionnaire
This questionnaire will assist the Bureau of Labor Statistics (BLS) in determining your eligibility to
access confidential microdata through the visiting researcher program and in completing the required
paperwork if your project is approved. For multiple researchers applying together, but affiliated with
different agencies, one questionnaire should be completed for each agency. Thank you for your
cooperation.
1. Applicant Information
Name:
Title:
Email:
Phone:
Fax:
Business
Mailing
Address:
Employment
Status:
Full-time employee
Other. Please specify:
Will you require access to the confidential information?
Yes
No
If yes, please provide a resume or CV.
2. Project Information
Title:
BLS Data
Set(s):
Non-BLS
Data Set(s):
Description of your approach to completing the project within a two-year time period. (For example, you
may plan to come to the BLS national office for three months to do your research all at once, or you may
plan to work periodically by coming once a month and researching a week at a time. Also, please detail
any special circumstances that may affect your availability to access data.
How will you present your research?
Report(s)
Journal Article(s)
Conference(s)
Other. Please specify:
3. Agency Information
Agency Name:
Is your office a statistical
and/or research unit?
Yes No
Signing Official: This official must have the authority to enter into legally-binding agreements on behalf of
the agency. Must be a contract officer, Senior Executive Service official, or agency head.
Name:
Title:
Email:
Phone:
Fax:
Mailing
Address:
4. Collaboration
Are you collaborating with any other Federal agencies or institutions for this project
(State agency or an educational institution)?
Yes
No
If yes:
What agency/institution(s)?
Please list the names of the
collaborators.
Specify if any of those collaborators
need access to confidential microdata.
5. Use of Contractors
Will you use contractors to access the
confidential information?
Yes No
If yes, please state the name of the
contractor and provide details (such as the
contract number and the name and contact
information of the agency employee
administering the contract).
6. Recipient Project Coordinator
Recipient Project Coordinator: A project coordinator must be an employee of the agency and serves as the
main point-of-contact between the BLS and the agency. An applicant may serve as project coordinator.
Check if same as applicant
If not the same as applicant, please fill out the following information:
Name:
Title:
Email:
Phone:
Fax:
Mailing
Address:
Employment
Status:
Full-time employee
Other. Please specify:
Will the recipient project coordinator require access to the confidential information?
Yes
No
If yes, please provide their resume or CV.
2
7. Additional Individuals Seeking On-site Access to Confidential Microdata
Please specify any additional individuals who require access to confidential microdata. Attach a resume or
CV for each individual.
1.
Name:
Title:
Phone:
Email:
Address at
Agency:
Employment
Status:
Agency employee
Contractor
Other. Please specify:
2.
Name:
Title:
Phone:
Email:
Address at
Agency:
Employment
Status:
Agency employee
Contractor
Other. Please specify:
3.
Name:
Title:
Phone:
Email:
Address at
Agency:
Employment
Status:
Agency employee
Contractor
Other. Please specify:
4.
Name:
Title:
Phone:
Email:
Address at
Agency:
Employment
Status:
Agency employee
Contractor
Other. Please specify:
5.
Name:
Title:
Phone:
Email:
Address at
Agency:
Employment
Status:
Agency employee
Contractor
Other. Please specify:
Privacy Act Statement. The information you provide will be used by staff at the Bureau of Labor
Statistics (BLS) to determine your eligibility for access to confidential BLS data and for other
administrative purposes. Providing the information on this form is voluntary; however, the BLS will not
be able to grant access to confidential BLS data without this information. The BLS is authorized to
request the information on this form under Title 5, United States Code, Section 301.
3
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Federal Researcher Questionnaire 2014 (Bureau of Labor Statistics)

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Completed 24 July 2020

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