Dutchess County, NY · Dutchess County
Data Request Form
Dutchess County Department of Behavioral & Community Health uses this form to collect information from people or organizations requesting data.
At a glance
- Issued by
- City of Dutchess County · Dutchess County, Dutchess County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- dutchessny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Use this form to request data from the Dutchess County Department of Behavioral & Community Health. It asks about the request’s purpose, needed variables, time period, population, geographic area, and preferred format. The form notes that processing may take up to two weeks and that individually identifiable health information cannot be released.
Who needs it
People or organizations requesting data from the Dutchess County Department of Behavioral & Community Health should complete this form.
How to submit it
Send the completed form to the Dutchess County Department of Behavioral & Community Health, 85 Civic Center Plaza, Suite 106, Poughkeepsie, NY 12601; fax it to 845-486-3561 or email [email protected].
About notarization
This form does not require notarization; it asks for no sworn attachment, so the requester completes the fields and submits it.
How to submit this form
- 1
Download the Form
Download the Dutchess County Data Request Form.
- 2
Complete the Request
Provide your contact details and describe the purpose, variables, time period, population, geographic area, and format requested.
- 3
Check Your Information
Review the request details. The form does not list any required attachments.
- 4
Submit to the County
Email or fax the form to the department, or send it to the address printed on the form.
Frequently asked questions
- What information does the Dutchess County Data Request Form ask for?
- It asks for the request purpose, variables, time period, population, geographic area, preferred data format, and the requester’s contact information.
- Do I need a notary for the Dutchess County Data Request Form?
- No. This form does not require notarization and asks for no sworn attachment; complete the fields and submit it.
- How do I submit the Dutchess County Data Request Form?
- Send it to the Department of Behavioral & Community Health at 85 Civic Center Plaza, Suite 106, Poughkeepsie, NY 12601, fax it to 845-486-3561, or email [email protected].
- How long may processing take?
- The form asks requesters to allow up to two weeks for processing. It also notes that individually identifiable health information cannot be released.