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Notice of Intent to Collect Private Data

The information we are asking you to provide about yourself is private data under the Minnesota Government Data Practices Act, Minnesota Statutes, chapter 13. Your enrollment in this program is completely voluntary. If you choose not to provide the requested information, the State will not have enough information to notify you about COVID-19 vaccination updates or opportunities that are relevant to you or to determine whether you are eligible to pre-register or be placed on a notification list for vaccination opportunities. Some questions have the option to select “prefer not to answer” and selecting that as your answer will not prevent you from being enrolled in this program.

State agencies involved in vaccine planning, scheduling, and administration will have access to your information. Others who may have access to your information are local public health agencies, health care providers, and other persons or entities involved in COVID-19 vaccine planning, scheduling, or administration, as well as persons or entities authorized by law.
Please provide your date of birth
Demographic Details
Do you work in any of the following industries (check all that apply):
Race
Cultural/Racial identity
Cultural/Racial identity
Other Details
Ethnicity Details
Please tell us if you have any of the following disabilities