Data Request

Please Note:

HSIS is designed to provide data to be used in research conducted in the general public interest, which is intended for publication in a scientific journal or other national publication. By submitting this request, the user is promising to follow these guidelines. Educators who wish to use HSIS data for instructional purposes in a road safety course should contact HSIS staff directly at Ana.Eigen@dot.gov. Users wishing to obtain data for purposes other than research or instruction should contact the States directly. HSIS staff will be pleased to provide contact names and addresses.

Before filling out the form, please review the data element tables to see which variables are available for a given state or the guidebooks for detailed descriptions and definitions.

Table Directions (please read first)

Table 1 — Data Elements for Accident, Vehicle, and Occupant Files
Table 2 — Data Elements for Roadway and Roadway-Related Files

Guidebooks:

I've read the notice

(you must check the notice box before completing the form)

Data Request Form

1. Please enter your name and contact information.

Name*

Address 1*

Address 2

City*

State*

Zipcode*

Phone number*

Fax

Email*

Confirm Email*

2. What is the specific research question you are addressing?*

3. Funding agency for this research project:*

4. How will the results of the research be used?*

5. When do you plan to publish the results and in which journal?*

6.If you are a graduate student, please provide the following information:

School

Faculty Advisor Information

Name

Address 1

Address 2

City

State

Zipcode

Phone number

Fax

Confirm Email

7.When do you need this data or information from us? (NOTE: "ASAP" means we get to decide priority. If you provide a date, we will try to meet the deadline or will negotiate a new deadline with you depending on other work, the nature of the request, etc. Please be as realistic as possible.)*

Please enter the text displayed in the image.*