I certify that no confidential data or information viewed or otherwise obtained while I am a researcher in the National Center for Health Statistics (NCHS), Research Data Center (RDC) will be removed from NCHS. Further, I understand that NCHS will perform a disclosure review and must provide approval to me before I remove any data from the RDC, whether it be in electronic or paper form. I understand any violation I may perform is punishable under 18 United States Code (USC) 1001 which carries a fine or up to 5 years in prison, or both.
18 United States Code 1001 - Knowingly and willfully falsifying, concealing, or covering up by any trick, scheme, or device a material fact or making any materially false, fictitious, or fraudulent statment or representation violates 18 USC 1001 and is punishable by a fine or up to 5 years in prison, or both.
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| Researchers Signature | Date |
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| NCHS Witness | Date |