Secure Anonymised Information Linkage (SAIL) Dataset Acquisition Request Form

Template review chronology Version no. Effective date Reason for change 1.0 21 January 2013 New form 2 SAIL Dataset Acquisition Request Form The purpose of this form is to enable SAIL to manage requests to bring a dataset into SAIL. It should be completed by the person requiring that a particular dataset comes into SAIL.

Section 1. Person requiring the dataset

Please provide your contact details: Name: Job title: Organisation: Address: Tel: Email:

Section 2. Data provider

Who is providing the dataset? Name of organisation: Contact person name: Address: Tel: Email:

Section 3. Dataset

Please provide brief details about the dataset: Name of the dataset:

On what basis is the dataset to be included in SAIL? Please indicate one of the following: As a core SAIL dataset available in accordance with our standard Information Governance

procedures? As a restricted access dataset, that requires the agreement of the data provider in

addition to our standard Information Governance procedures? As a restricted access dataset, available only to the specific project?

Which project is the dataset required for? Please indicate any relevant deadlines for bringing the dataset into SAIL: Required by (date): Please explain why the dataset is required by this date:

What to do next 2 Please return your completed form by email to the SAIL Team [email protected]. Thank you.

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