Project Feasibility and Data Access Quote Form

For assistance in completing this form, please contact our Project Coordinator at (506) 447-3320 or by email . Allow a minimum of 10 working days for processing of this form.

Full name:
Email address: / Telephone: / (xxx) xxx-xxxx /
Mailing address:
Affiliation: / Choose one / If other, describe:
Name of affiliation: / Position:
Is this a thesis? / ☐Yes ☐No / Academic Unit:
Supervisor:

Provide the following details for all persons who will be doing data analysis in the NB-IRDT lab. Additional rows can be added to the table ifnecessary.

Name / Organization / Position in Organization
Have you applied for funding? / ☐Yes ☐No / Amount expected:
Source of funding:
Funding term: / Click here to enter start date / Click here to enter end date
Name of PI on funding submission:
Affiliation:
Full project title:
Briefly explain the purpose of this project. What are the overall objectives?
Type of submission: / Choose one
Is this project associated with another NB-IRDT project? / ☐Yes ☐No
If yes: title and reference number:
Has this project received support by MSSU or is it affiliated with another SPOR network? If yes, describe below. / ☐Yes ☐No
Type of study: / ☐Case control / Type of analysis: / ☐Descriptive
☐Cohort / ☐Statistical
☐Cross-sectional / ☐Spatial
☐Longitudinal / ☐Simulation based
Other: / Other:
Provide a brief description of the methodology planned for this project:
How many days will your team use the NB-IRDT lab?
(If more than one person is involved, include every researcher’s day as 1 day.)
List any analytical support you wish NB-IRDT to provide (e.g. data setup, analysis, etc). Further details may be necessary to provide a quote if NB-IRDT resources are requested.

All data sources being used for the study and requiring approvals - both NB-IRDT and non-NB-IRDT data - must be identified. Descriptions of the following data sets can be found at go.unb.ca/fr-nbirdt.

Indicate which of the following NB-IRDT data sets will be required and identify the time span of interest:

NB-IRDT Data Set / Start Date / End Date
☐ ALS Registry / Start Date / End Date /
☐ CCDSS COPD Data / Start Date / End Date /
☐ CCDSS Diabetes Data / Start Date / End Date /
☐ CCDSS Hypertension and Neurological Conditions / Start Date / End Date /
☐ Citizen Database / Start Date / End Date /
☐ Discharge Abstract Data / Start Date / End Date /
☐ Healthy Toddler Assessment / Start Date / End Date /
☐ NB Breast Cancer Screening / Start Date / End Date /
☐ NB Cancer Registry / Start Date / End Date /
☐ Physician Billing / Start Date / End Date /
☐ Provider Registry / Start Date / End Date /
☐ Vital Statistics / Start Date / End Date /
☐CCDSS MS Data (coming soon) / Start Date / End Date /
☐HbA1c Data (coming soon) / Start Date / End Date /
☐Immigrant Landing Records (coming soon) / Start Date / End Date /
☐Long Term Care (coming soon) / Start Date / End Date /
☐ NB Drug Plan Data (coming soon) / Start Date / End Date /
☐NB Trauma Data (coming soon) / Start Date / End Date /
LIMITING COLLECTION
Will this project involve using data that are notcurrently available at NB-IRDT? / ☐Yes ☐No

If yes, complete the following table. Additional rows can be added if necessary.

Name of Data Set / Origin of Data Set / Scope
e.g. general content, start/end dates, individual/aggregate level data, etc
Are there any other issues that NB-IRDT staff should be aware of pertaining to this project?

Revised date:March 2018Page 1 of 5