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NSHD Data and/or Biological Samples Access Request Form

Version Draft: 1.1

- Name of all applicants, affiliations and contact details

(include telephone numbers and email addresses and extend form as necessary where there are more applicants)

Principal Applicant Name:
Co-applicant (1) Name:
Co-applicant (2) Name:

- Has your application been discussed with anyone from the LHA team?

(If yes, please state name)

- Project Dates

Start Date:End Date:

- Title of project (less than 30 words):
- Funding: Has/will the project be(en) peer reviewed and funded?

(If yes, please state organisation which has reviewed (or will review) project and their decision. Please enclose grant proposal, response, and referees’ comments as an appendix)

- Brief description of project including proposed outputs

(No more than 1-2 sides A4 with up to 10 key references.

- Rationale for undertaking this project with the MRC NSHD data set
- Are other datasets included on this project?

(If yes, please specify the other studies involved)

- Does your project involve genotyping?

(If yes, please specify a) list of SNPs to be genotyped, b) pre-existing data on genotype frequency and c) reference any of the applicant’s previous experience in this area)

- Does your project involve DNA?

(This is only provided in certain circumstances, please see guidelines. State amount, rationale for request for DNA, and describe the processes to be carried out, then continue to questions 11, 12 and 13)

- DNA samples: Are there any special requirements for the DNA extraction or potential problems with using pre-amplified rather than genomic DNA?

Please specify

- Does your project involve RNA or other cellular material?

(If yes, please state amount and rationale for request, and describe the processes to be carried out. Also answer questions 7e)

- and quality control: Does (Do) the applicant(s) have sufficient experience and expertise to carry out the DNA or RNA investigations described?

(please cite relevant publications)

- Have you undertaken a sample size calculation?

(If yes, please provide details of sample size calculations on your proposed study. If no, please justify why these have not been undertaken. Applications that have not considered sample size requirements adequately may be rejected.)

- Analyses: What variables from the NSHD database will be required for statistical analysis?

(If you need clarification on our existing variables, please email mrclha.swiftinfo@ucl.ac.uk to arrange a time to visit to look at study materials and discuss your request with the study team)

- Do you require statistical input from NSHD statisticians to undertake the analyses?
- Electronic data: Will the project require deriving or producing new variables from existing data?

(Please specify)

- Within your organisation, who will be responsible for managing the information security of any NSHD data shared with your organisation?
- What policies does your organisation have in place to safeguard the confidentiality, integrity and availability of digitally stored information? (please include URLs if appropriate)
- Does your organisation have NHS IG Toolkit certification or any other relevant audited security assurance?
- What is the location of the data centre or servers which will be used to store any NSHD data supplied to you?
- How will NSHD data be stored and backed up during your project?
- How will access to NSHD data be controlled?
- Who will be responsible for the day to day data management of any NSHD data shared with your project?
- How will NSHD data be destroyed at the end of your project?

- How did you find out about the NSHD?

(Please specify any web links or other resources you used)

Signature ________________________ Date ___________

Print Name ___________________________
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