Data Request Form

Review available data, before submitting a request, most information is available on the website.

Read through the following before submitting your data request:

 

Fill out the entire form and provide detailed information.
All fields with an asterisk (*) must be completed.

Part 1: Requester Information

Part 2: Data Request Information

(e.g., "How many people were vaccinated with Gardasil in 2018, 2019, and 2020?")
(e.g., Varicella, Gardasil/HPV, etc.)
Note: See our Vaccines page for a list of vaccines.
(e.g., December 14th, 2021–Present day, 2017–2018, etc.)
(e.g., count of people vaccinated, count of doses administered, age of people vaccinated, etc.)
(e.g., specific age group, race/ethnicity, county, etc.)
(e.g., increase coverage rates, monitor )
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