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Sample Data Request Form

The document is a Data Request Form from the Department of Information and Communications Technology, outlining the process for submitting requests for data. It includes instructions for filling out the form, a data privacy statement, and sections for general information, details of the request, endorsement, and approval. The form ensures that personal data is handled in compliance with the Data Privacy Act of 2012.

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dict.alexatojos
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24 views1 page

Sample Data Request Form

The document is a Data Request Form from the Department of Information and Communications Technology, outlining the process for submitting requests for data. It includes instructions for filling out the form, a data privacy statement, and sections for general information, details of the request, endorsement, and approval. The form ensures that personal data is handled in compliance with the Data Privacy Act of 2012.

Uploaded by

dict.alexatojos
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Department of Information and Communications Technology

Management Information Systems Service

DATA REQUEST FORM


DICT-MISS-DRF-2022v1.1

READ THE INSTRUCTIONS BEFORE FILLING OUT THE FORM:


1. Fill out this form completely and accurately.
2. Tick the checkbox of DATA PRIVACY STATEMENT.
3. Do not leave any information blank.
4. Do not abbreviate (e.g., MISS should be Management Information Systems Service)
5. Multiple requests of account are per one system only.
6. When your request is completed, you will be notified through your e-mail address provided on this form.
7. You may contact [email protected] to follow up on your request.
 DATA PRIVACY STATEMENT
The registrants are assured that the personal data and other sensitive data entrusted to DICT shall be used with due diligence and prudence, for the sole purpose of
this request. As such, upon filling out the Data Request form, you acknowledge and agree that the information may be used and disclosed by the DICT in accordance
with any legal and regulatory standards and in compliance with the “Data Privacy Act of 2012”.

Reference No. Date of Request

GENERAL INFORMATION

Contact Person Designation

Bureau/Office/Service Division/Project

Email Address Mobile/ Local Number

DETAILS OF REQUEST

Reason of Request  Data Request – Request for generation of data from existing database/system
 Data Change Request – Request to make changes to existing data/record
 New Data – Request for creation or inclusion of new data

Information System  Intranet  PMIS  eOR  eHRMIS  DocTracks

Detailed Statement of
Request

(Attached relevant
documents as needed)

Urgency  High  Medium  Low

ENDORSEMENT (to be filled out by Requesting Unit Supervisor)

Signature Over Printed Name

APPROVAL (to be filled out by MISS)

Assumptions and Notes

Recommending Approval: Date:

LEAD, MISS-DWAD

Status  Approved  Approved as Modified  Disapproved  Withdrawn by Requester

Date:

CHIEF, MISS-DWAD

Remarks

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