Before filling out the form, please go to the generic variable tables to choose appropriate variables for your request.
Before viewing the tables, please read the directions for using the tables.

View Table 1 - For Accident, Vehicle, and Occupant Files
View Table 2 - For Roadway and Roadway Related Files

NOTE: The Highway Safety Information System (HSIS) is a cooperative endeavor funded by the US Federal Highway Administration, with data voluntarily provided to FHWA by the participating states. The system is designed to provide data to be used in research conducted in the general public interest which is aimed for publication in a scientific journal or other national publication. By submitting this request, the user is promising to follow these guidelines. Users wishing to obtain data for other purposes should contact the states directly. HSIS staff will be pleased to provide contact names and addresses.

Please answer the following questions for each research issue that you wish to use HSIS data in. This will help the HSIS analysts in providing you with the needed files/output. Please use extra sheets if additional room is needed, and be as explicit (and extensive) in your explanation as you can.

ALL requestors should answer questions 1-7. If you are requesting output other than data files (e.g., tables, results), answer question 8 only. If you are requesting data files, skip to questions 9-10. Please fax or send the completed form to: Anusha patel Nujjetty at HSIS Lab, 6300 Georgetown Pike, Room T-211, McLean, VA 22101. (Email: anushapatel.nujjetty.CTR@dot.gov Fax: 202-493-3374.

1. Please enter your name, office, and telephone number.

Name:
Address:
Phone number:
Fax:
E-mail address:
Date of Request:

2. What is the specific research question you are asking?

3. Name of the sponsoring agency:

4. What will your results be used for?

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

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

School:
Name of the Faculty Advisor:
Advisor Address:
Advisor phone number:
Your E-mail address:

7. When do you have to have 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 answer question 8 if you are requesting information other than data files (e.g., tables, results). If data files, skip to questions 9- 10 (Use additional sheets as necessary).

8. What do you want the output to look like (e.g., rates, variables for models, tables)? If output is a table or series of tables, draw the table below showing the labels and categories for each axis. Also define what you want to see in each cell (e.g., frequency of accidents, rates, number of miles, ADT, etc.)

9. What specific data variables do you need? Please provide following information for each file requested (Please provide one sheet/state. Refer to the HSIS Guidebooks for help):

State Name:
Year(s) for which data is requested:
File Name 1:

List of Variables:

File Name 2:
List of Variables:

Etc. -- Add additional sheets as necessary.

10. How would you like the data to be delivered? Please check all applicable:
3.5" disk 8mm data tape CD-ROM Optical disk FTP E-mail

11. Please check desired format:
SAS SPSS EXCEL ASCII OTHER