Public Benefit and Privacy Panel for Health and Social Care Application Form Application Control Applicants should not complete the date” field “submitted Application Coordinator Application Number Submitted Date Applicant Name Proposal Name Project End Date Pre-submission checklist Applicants should not fill out this section to be completed by the eDRIS coordinator – Approved Information Approved training complete and certificates received Governance Training Approved training complete and certificates pending Use of recognised safe haven Yes No NHSCR Involvement Yes Reference number:................ Email Confirmation of approval supplied: No Is project covered by National Yes Safe generic ethics No approval? Supporting Documents Please list only supporting documents which you have clearly referenced in your application the name of each should clearly indicate what the document/file/reference is about. – Note to Applicants Prior to completing your application form you should:
Public Benefit and Privacy Panel for Health and Social Care Application Form Application Control Applicants should not complete the “submitted date” field Application Coordinator Application Number Submitted Date Applicant Name Proposal Name Project End Date Pre-submission checklist Applicants should not fill out this section – to be completed by the eDRIS coordinator Approved Information Governance Training Approved training complete and certificates received Approved training complete and certificates pending Use of recognised safe haven Yes No NHSCR Involvement Yes Reference number:................ Email Confirmation of approval supplied: No Is project covered by National Safe generic ethics approval? Yes No Supporting Documents Please list only supporting documents which you have clearly referenced in your application – the name of each should clearly indicate what the document/file/reference is about. Note to Applicants Prior to completing your application form you should:
Application-form-v3.0.docx