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Please provide information on additional Co-Principal Investigators, if applicable.

3. Title of research project for which this restricted data file is requested.

4. Short description of research project including research questions, primary methodology, categories of variables to be used (attach additional sheets if required).

5. What types of data from other sources will be merged with this restricted data file?

6. State reasons why the public-use data file is not adequate for conduct of the research project.

7. Describe all the ways that you intend to use the results of the research, including plans for public dissemination.

8. Provide names, titles, and affiliations of other members of the research team who will have access to the restricted data or to output derived from these data. If not all members have been selected, please list as "unassigned" and indicate the job titles. Include individuals who are employed by different organizations.

9. If employed at an organization that has a current NIH Multiple Project Assurances (MPA) Certification Number or Federal Wide Assurances (FWA) Certification Number, please provide the number and expiration date.

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