R EQUEST TO ACCESS CONFIDENTIAL MICRODATA FOR SCIENTIFIC PURPOSES

STUDENT ID DUPLICATE CREDENTIAL REQUEST FEE CHARGED
(JAWAPAN PADA SLAID) 1 A MANAGER REQUEST HIS
048B DATE OF BIRTHADDRESS CHANGE REQUEST FORM

2 REQUEST FOR NCG FUNDING FOR RITUXIMAB
2 REQUEST FOR URGENT CITIZENSHIP CEREMONY –
APPLICATION TO THE REGISTRAR TO REQUEST THE PRODUCTION

R equest to access confidential microdata for scientific purposes

1. Information of the research entity

1.1 IDENTIFICATION of the entity requesting access

Entity name:

Address:

Webpage:

Country:

Type of entity:

University or higher education entity

Research organisation

Other (please specify):

2. Objective of the research project

2.1 Title of the research project

2.2 description of the research project for which the access to confidential microdata is requested (maximum 2 sheets)

2.3 objectives of the research project

2.4 why could the research project not be carried out without the access to confidential microdata?

3. Data to which access is requested

3.1 STATISTICAL operation from which data is required

3.2 variables and degree of breakdown required for the research project

3.3 statistical methods used for the analysis of data

4. Results of the statistical analysis

4.1 Presentation of the results FROM the analysis (results tables by variables, graphs, degree of breakdown, etc.)

4.2 dissemination of the results FROM the analysis (publication of articles, conferences, etc.)

5. Data security

5.1 Physical security measures present in the facilities where data will be kept (locked compartments or rooms, etc.)

5.2 Logical security measures of the units where data will be kept (access passwords, data encryption, etc.)

5.3 ADMINISTRATIVE security measures of the facilities where data will be kept (identification required to access the facilities, register of each access to files, etc.)

5.4 Measures used to destroy confidential information once it is no longer necessary or when the RESEARCH PROJECT is finished (paper shredders, data-erasing software, etc.)

6. Information of the research team that will access the data

6.1 number of members of the research team

6.2 research manager

Name:

Position:

E-mail:

Research entity:

6.3 RESEARCHERS that will have access to the data^¹

Researcher

Name:

Position:

Research entity:

Researcher

Name:

Position:

Research entity:

Researcher

Name:

Position:

Research entity:

Researcher

Name:

Position:

Research entity:

Researcher

Name:

Position:

Research entity:

S tatement on the submitted documents relative to the request to access confidential microdata for scientific purposes

Concerning the request to access confidential microdata for scientific purposes for project:

Research manager:

The undersigned hereby declares that the information given in the request to access confidential microdata, in order to carry out the aforesaid research project, is full and accurate. Any changes will be notified immediately to the National Statistics Institute (INE).

The research manager agrees that the INE may check the accuracy of the information provided at any time, and that the INE may request additional information if necessary.

(City) on 2

Signed,

Research manager

1 More fields can be added in order to gather the identification of all the members in the research team.

CHAIRMAN PHIL MENDELSON AT THE REQUEST OF THE
EQUESTRIAN AUSTRALIA DRESSAGE NATIONAL YOUTH SQUAD
FREEDOM OF INFORMATION ACT REQUEST PLEASE REVIEW

Tags: access confidential, to access, access, purposes, microdata, scientific, confidential, equest