Form Registration for new Research Projects

							UCL RECORDS OFFICE




                                       DATA PROTECTION REGISTRATION
                                                  form 2
                     APPLICATION FOR INCLUSION OF A RESEARCH PROJECT
     This form should be used to Register Research Projects that will be supported by UCL facilities. It
     should be completed in full and returned to the UCL Data Protection Officer before Data Collection
     commences.
     If the Data has been collected from an organisation outside UCL then the Patient, or Subject, of the
     Data must have given their consent to both the collection of the Data and the transfer of the Data to
     UCL. A copy of the Patient Consent Form must be attached to this application. If you are not obtaining
     Patient Consent then an explanation must be attached.



     DEPARTMENT


     Please return this form to: The UCL Data Protection Officer, The Records Office. South Junction, Wilkins
     Building, Gower Street London WC1E 6BT Or Email to: data-protection@ucl.ac.uk

     Please allow five working days in which to receive your Data Protection Registration No.
      Name of Principle
      Investigator (Student                                   Name of Data Collector
      Supervisor)?                                            and User?



      Please state here the Title
      of your research Project?


      Address for
      correspondence
      regarding this
      application:




     Email Address:



     Telephone No.



     University College London Gower Street London WC1E 6BT
     Tel: +44 (0)20 7679 7783 Fax: +44 (0)20 7419 2810
     www.ucl.ac.uk/efd/efm_www/recordsoffice/

     February 2008
Are you: Applying to the
UCL Ethics Committee                                     How will the Data be
for Ethics Permission?                                   stored? (Electronic
(Yes/No)                                                 Database/ Paper Files)



What Security Checks do
you have in place?
(Password on Electronic
Database, Locked Filing
Cabinets?


NB: Once the Research Project is completed, please contact the Records Office.

Email to: records.office@ucl.ac.uk to arrange ongoing secure storage of your research records

http://www.ucl.ac.uk/efd/recordsoffice/policy/records-transfer/

unless you have made specific alternative arrangements with your dept or with your funder

Have you registered your
Database with your
Department's Computer
Representative?
(Yes or No)                                              Please state where the
NB: For data held on                                     data will be held?
UCL Central servers
rather than your
department's servers you
should contact:
cert@ucl.ac.uk

Have you informed your
Department's Data
Protection Co-ordinator
about your project? (Yes                                 How long will your project
or No)                                                   last?
NB: DP Officer will not
be informing Dept DP Co-
ordinator directly




University College London Gower Street London WC1E 6BT
Tel: +44 (0)20 7679 7783 Fax: +44 (0)20 7419 2810
www.ucl.ac.uk/efd/efm_www/recordsoffice/

February 2008
The following are the standard Data Protection Registration Purposes and Descriptions. If your
research is not covered by these please add the information at the end:
Please indicate using a (X) what is applicable to your research project
Personal Data will be collected from the following Data Subjects: (Who will you be
collecting the data from)?
        Survey respondents, other persons
        assisting research
         Patients
         Patients families
         Employees, trainees, voluntary workers
         Employees of associated companies, organisations
         Employees of other organisations
         Recipients,customers or clients for
         goods or services (direct or indirect)
         Suppliers of goods or services (direct or indirect)
         Claimants, beneficiaries, payees
         Account holders
         Share and stock holders
         Partners, directors, other senior officers
         Employers
         Competitors
         Business or other contacts
         Advisers, consultants, professional and other experts
         Agents, other intermediaries
         Trustees
         Members, supporters a club, society, other institution
         Assignees, guarantors, other parties with legitimate contractual or business
         interest
         Donors and lenders
         Witnesses
         Complainants
         Offenders and suspected offenders
         Tenants
         Landlords, owners of property
         Correspondents and enquirers
         Self-employed persons
         Unemployed persons
         Retired persons
         Students
         Minors (if you are collecting data from minors, please include the
         Parent or Guardian Information Sheet and Consent form with your
         application)
         Applicants for permits, licences, registration
         Taxpayers, ratepayers
         Licence holders
         Vehicle Keepers
         Elected representatives, other holders of public
         office
         Authors, publishers, editors, artists, other creators
         Immigrants, foreign nationals
          Relatives, dependants, friends, neighbours,
          referees, associated, contacts of those ticked above


University College London Gower Street London WC1E 6BT
Tel: +44 (0)20 7679 7783 Fax: +44 (0)20 7419 2810
www.ucl.ac.uk/efd/efm_www/recordsoffice/

February 2008
        Other: (specify):

      Description of Personal Data to be collected: (What data will you be collecting)?
                                                                 Health & safety record
Identification data                                              Trade union, staff association membership
         Personal identifiers                                    Payment, deductions
         Financial identifiers                                   Property held by employee
         Identifiers issued by public bodies                     Work management details
 Personal characteristics                                        Work assessment details
         Personal details                                        Training record
         Physical description                                    Security details
         Habits                                          Financial details
         Personality, character                                  Income, assets, investments
 Family circumstances                                            Liabilities, outgoings
         Current marriage or partnership                         Loans, mortgages, credits
         Marital history                                         Allowances, benefits, grants
         Details of other family, household                      Insurance details
         members                                                 Pension's details
         Other social contacts                           Details of transactions
 Social circumstances                                            Goods, services provided to the data subject
         Accommodation or housing                                Goods, services obtained from the data
         Property, professions                                   subject
         Immigration status                                      Financial transactions
         Travel, movement details                                Compensation
         details                                         Business information
         Leisure activities, interests                           Business activities of the data subject
         Lifestyle                                               Agreements, contracts
         Membership of voluntary, Charitable                     Trading licences held
         bodies                                          Health and other classes
         Public offices held                                     Physical health record
         Licences, permits held                                  Mental Health Record
         Complaint, incident, accident details                   Disabilities, infirmities
         Court, tribunal, inquiry proceedings                    Dietary and other special health
 Education, Skills, Profession                                    requirements
         Academic record                                         Sexual life
         Qualification and skills                                Racial, ethnic origin
         Membership of professional bodies                       Motoring convictions
         Professional expertise                                  Other convictions
         Membership of committees                                Criminal intelligence
         Publications                                            Political opinions
         Student record                                          Political party membership
 Employment details                                              Support for pressure groups
         Current employment                                      Religious beliefs
         Recruitment details                                     Other: data class (specify):
         Termination details
         Career history
         Work record

University College London Gower Street London WC1E 6BT
Tel: +44 (0)20 7679 7783 Fax: +44 (0)20 7419 2810
www.ucl.ac.uk/efd/efm_www/recordsoffice/

February 2008
                              The Results of the Research will be Disclosed to:
                                                                Social Services department
Individuals or Organisations directly associated with
the Data Subjects                                                Electoral registration, Assessment,
       The Data Subjects themselves                              Valuation departments
       Family, relatives, guardians, trustees            Other public bodies
       Other members of their households,                        Other public bodies not elsewhere specified
       friends, neighbours                                       Foreign governments and authorities
       Employers - past, current or prospective                   (specify):
       Employees, agents                                 Justice
       Colleagues, business associates                           Police forces
       Legal representatives                                     Prosecuting authorities
       Financial representatives                                 Other statutory law enforcement agencies,
       Legal representatives                                     Investigating bodies
       Financial representatives                                 The courts
       Doctors, Dentists, other advisers                         Judges, magistrates
       Social, spiritual, welfare, advice workers                Prison service
       Other professional advisers                               Probation service
       Landlords                                         Health & Social welfare
Individuals or Organisations directly associated with            Health authorities, family practitioners
the Data User                                                   committees
       Research Sponsors                                         or Family Health Service Authorities
       Funding Agencies                                          Hospitals, nursing homes
       Ethics Committees                                         Registered medical practitioners
       Members, including shareholders                           Registered dental practitioners
       Other companies in the same group                         Nurses, midwives, health visitors
       Employees, agents                                         Other health care agencies, practitioners
       Recipients, customers, clients for goods or                (specify):
        services                                                 Social welfare agencies, practitioners
       Claimants, beneficiaries, assignees, payees              (specify):
       Suppliers, providers of goods or services         Other
       Persons making any enquiry or complaint                   Media
       Tenants                                                    Public utilities
       Other: (specify):                                         Banks
                                                                 Building societies
Organisation or individuals (general description)                Insurance companies
Central Government                                               Other financial organisations (specify):
       Inland Revenue                                            Accountants & auditors
       Customs & Excise                                          Lawyers
       Driver & Vehicle Licensing Centre                         Credit reference agencies
        (DVLC)                                                   Debt collection, tracing agencies
       Department of Education & Sciences                        Employment, recruitment agencies
        (DES)                                                    Private detective agencies, security
       Departments of Health and/or Social                        organisations
        Security                                                 Trade, employers associations
       Department of Employment                                  Trade unions, staff associations
       Home Office                                               Professional bodies
       Ministry of Defence, including armed                      Voluntary, charitable, religious organisations or
        forces                                                    associations
       Department of Constitutional Affairs                      Political organisations
       Other central government, including                       Education or training establishments,
        Scottish                                                  examining bodies
       Welsh & Northern Ireland Offices                          Survey or research organisations, workers
       Other (specify):                                          Providers of publicly available information,
Local Government                                                  including public libraries, press and media
       Education department                                      Providers of privately available information
       Housing department                                and
University College London Gower Street London WC1E 6BT
Tel: +44 (0)20 7679 7783 Fax: +44 (0)20 7419 2810
www.ucl.ac.uk/efd/efm_www/recordsoffice/

February 2008
         databanks                                                           Other organisation or individuals (specify):
         Traders in personal data                                            Other: (specify):


 Will the Results of
 your Research be
 published in an
 Academic Journal
 or other
 Publication?
 (Yes or No)

Please note that if you do publish the results of your Research they must not contain data by which an
individual can be identified.



 B4. Overseas Transfer
 The Eighth Data Protection
 Principle.                                    Are you collecting the Data in a country outside of the EEA?
 Personal data shall not be
 transferred to a country or                   Yes          No
 territory outside the European
 Economic Area unless that                     Please attach a copy of the Data Protection Registration in that
 country or territory ensures an               country
 adequate level of protection for
 the rights and freedoms of data
 subjects in relation to the
 processing of personal data.
                                               Do you intend to transfer the Data to any other country or territory?
 The European Economic Area                    Yes         No
 consists of the twenty seven member
 states of the European Union
 together with Iceland, Liechtenstein,         Please give details and attach a copy of your agreement with the
 Norway and the States of Guernsey             recipient.
 and Jersey. Data may be transferred
 within the European Economic Area
 without restrictions.




 This form will be returned to you with the appropriate UCL Data Registration References, which you
 may quote on your Ethics Application Form, or any other related forms.

 UCL Data
 Protection
 Registration                                                  SECTION:
 Reference No:

 Any queries regarding this form please contact: Tel: 020 76790166 (UCL ext.30166)



 University College London Gower Street London WC1E 6BT
 Tel: +44 (0)20 7679 7783 Fax: +44 (0)20 7419 2810
 www.ucl.ac.uk/efd/efm_www/recordsoffice/

 February 2008