Section 845.APPENDIX B   Information Agreement

The Illinois Department of Public Health ("Department") and _________________________

("Applicant"), agree as follows:

1)         The Department will provide data dealing with children who have been tested for lead poisoning in Illinois as outlined in the letter of application.

2)         The applicant agrees that:

a)         Use of data is restricted to the purpose outlined in the letter of application (Attachment A), and any other or additional use of the data may result in immediate termination of this agreement by the Department;

b)         Any and all data that may lead to the identity of any child or parent, research subject, physician, informant, other person or hospital is strictly privileged and confidential. Applicant agrees to keep all such data strictly confidential at all times;

c)         All officers, applicants and employees of Applicant will keep all such data strictly confidential. Applicant will communicate the requirements of this Section to all officers, applicants and employees, will discipline all persons who may violate the requirement of this section, and will notify the Department in writing within 48 hours after any violation of this section, including full details of the violation and corrective actions to be taken;

d)         All data provided by the Department pursuant to this agreement are the sole property of the Department.  Any copies by applicant of data provided by the Department pursuant to this agreement are subject to all provisions contained in this agreement.  Any copies of data created by Applicant will be destroyed upon completion of the purpose outlined in the application;

e)         The applicant agrees to forward to the Department copies of proposed publications containing data or interpretation of data received as a result of this agreement for the sole purpose of confirming compliance with this agreement;

f)          Any breach of any of the provisions of this agreement will void the agreement.

3)         The Applicant further agrees to state in publications and presentations concerning research that is the subject of this agreement that the Department was the source of data and conclusions, opinions and recommendations are not necessarily those of the Department.

4)         The Applicant and the Department understand and agree that this agreement may not be sold, assigned or transferred in any matter and that any actual or attempted sale, assignment or transfer shall render this agreement null, void and of no further effect.

5)         This agreement shall take effect upon signature by the Applicant and the Director of Public Health.

6)         All notices required or requested by either the Department or the Applicant shall be sent to the following addresses:

To the Department:

Illinois Department of Public Health

Childhood Lead Poisoning Prevention Program

535 West Jefferson Street

Springfield, Illinois 62761

To the Applicant:

7)         The Applicant and the Department understand and agree that this agreement constitutes the total agreement between them and that no promises, terms or conditions, either oral or written, express or implied, not recited, incorporated or referenced in this agreement shall be binding.