Annex №1, pursuant to art. 1, para. 1

QUESTIONNAIRE

To be completed by organisations applying for access to anonymised individual data which the NSI can provide for the purposes of scientific work according toart. 26aof the Statistics Act.

  1. Applying organisation:

(Please fill in the name)

  1. Yourorganisation is:

(Please enter “YES” on the corresponding row, which corresponds to the type of your organisation)

  1. Higher School

  1. Scientific-research Institution

  1. Legal entity whose main activity is scientific research

  1. Legal entity that has a separate unit/units for scientific research

  1. State Institution

  1. Non-governmental Organization

  1. International Organization

  1. Other

3. Attestation of the status and activity of your organization

(Please enter “YES” on the corresponding row, which corresponds to the status of your organisation and attach the relevant document/documents)

1. Legal act of establishment
2. List if the main shareholders, their activities and addresses
3. List of members of the Board of directors, their activities and addresses
  1. Organizational Chart – place of the unit/units that will carry out research

  1. Main objectives and activity

  1. Sources of funding

  1. Previous and current research projects:
-Subject of the research
-Date and place of the research
-Funding of the research
-Publication of the results
  1. Authorized person representing the organisation in providing access (name, position, address data)

4. Guarantees of confidentiality

(Please answer “Yes”or“No” for each row)

1. Personnel involved in the research project will be subject to security checks and screening
2. Staff will signsworn statements for statistical confidentiality in accordance with Art. 26 , item 1 of the Law on Statistics
3.Disciplinary sanctions shall be imposed on employees of the organization who might have asked the staff with right to access for any information concerning individual records

5. Please specify the technical and technological protection of the data that will be provided to you.

(Please answer “Yes”on the relevant row)

In case of a positive answer, please describe the means for technical and technological protection bellow.

  1. Description of the computer system used by the research unit

  1. Maintenance and management of the computer system used for data processing

  1. Description ofthe networkof the research unit (Firewalls, antivirus protection, protection and detection of unauthorized access, email security, etc.)

  1. Provision of safe storage of the processed data

  1. Prevention of unauthorized copying of data

Description the means for technical and technological protection

(Please describe)

6. Dissemination of the results of the processed data

(Please describe the policy on dissemination of the results from your research(publications, reports, conferences, web site, etc.)

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