ADMIN FORM - Data Request Form

Any person requesting data must complete this form and submit it. This will then be reviews by our Data Protection Officer. Access All Care and Training Solutions Ltd. will respond to all data requests within 28 days of recipt.

Should you have any further questions regarding data request please contact our Data Protection Officer using the following email address siobhan.wade@accessall.org.uk.

Applicant and organisation information.
Name Name First Last
Job Title
Organisation Name (if applicable)
Organisation Address (If applicable) Organisation Address (If applicable)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Contact Number
Individual the data is regarding
Name Name First Last
Date of birth Date of birth / MM / DD YYYY
Data specification
Indicate the dataset(s) needed for the processing activities (all datasets necessary for the conduct of the project):
Classification of data requested

Classification of data requested Anonymous De-personalised Personally Identifiable

Anonymous - All direct identifiers are removed.

De-personalised - All direct identifiers are removed. but contains fields which could be used to indirectly identify an individual (eg. ethnicity, sex, month and year of birth, or other personal characteristic).

Personally Identifiable - The data request includes direct identifiers (eg name, address, , date of birth).
Frequency

Frequency One - off Periodic - Monthly Periodic - Quarterly Periodic - Annually Other Other
Any additional information
Declaration

By submitting this form you are confirming that the statements below are true.

*I certify that the information contained in this application form is true, correct and complete and understand that any misrepresentation may invalidate my application or lead to delay in access to data.

* I understand that I may need to provide further information to prove my identity in order to received data.

* I understand that I may be asked to provide additional information to help locate the records requested
Outcome and Actions
Please detail actions and outcomes and who completed them.

ADMIN FORM - Data Request Form

ADMIN FORM - Data Request Form

Applicant and organisation information.

Individual the data is regarding

Data specification

Outcome and Actions