Interagency Data Exchange Agreement (IDEA) Dispute Mediation Request

Please use this form to request mediation from the Statewide Chief Data Officer for disputes related to a Business Use Case Proposal under IDEA.

Data recipient state entity

Select the state entity receiving the data by clicking (+ Add) and selecting from the list. Then provide details below for the primary contact.

Add

Data recipient primary contact: Name

Data recipient primary contact: Email

Data recipient primary contact: Phone

Data provider state entity

Select the state entity providing the data by clicking (+ Add) and selecting from the list. Then provide details below for the primary contact.

Add

Data provider primary contact: Name

Data provider primary contact: Email

Data provider primary contact: Phone

Business use case name

Give your business use case a name

Business use case summary

Summarize your business use case

Business use case data description

Describe the data being provided to meet the use case

Type of dispute (mark all that apply)

Please provide a brief summary of the dispute

Summary of dispute

Please provide a brief summary of the dispute.

Upload files

Please attach written comments and recommendations regarding this dispute from both the Data Recipient and Provider.

Attach file

Drop files here

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