COVID-19: MN HMIS Data Request Form
Due to the COVID-19 (coronavirus) public health emergency declared in the United States in March 2020, the Institute for Community Alliances (ICA) has implemented a process to review requests from public health officials and/or their designees for data housed within Minnesota's Homeless Management Information System (HMIS).

The primary purpose of this form is to receive requests for data related to an individual with a presumptive or confirmed diagnosis of COVID-19, including current or prior known “stays” within projects participating in HMIS. These requests should be in partnership with a public health entity.

All other COVID-related requests for personally identifiable information for specific individuals can be submitted through this form, however they will be managed and guided through ICA’s standard policies for data privacy and confidentiality.


STEPS:

1) Fill out and submit the following form, noting all required information.

2) A copy will automatically be delivered to ICA MN staff via the Helpdesk. If you have additional questions or need to add further clarity to your submission, please email the Helpdesk directly at mnhmis@icalliances.org.

3) Your data request will be reviewed as quickly as possible and you will receive a response within 2 business days confirming next steps.
Email address *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy