NICOR DATA ACCESS APPLICATION EVALUATION FORM NICOR APPLICATION REFERENCE: Project title: PI: Date of submission: Date evaluation due: Please rate/score each of the following sections (guidance notes separate): Section 1 Areas to consider (prompts) Evaluation criteria Score Excellent Good Satisfactory Poor Very poor 5 4 3 2 1 Areas to consider (prompts) NHS Research Ethics R and D CAG Other datasets Evaluation criteria Score Excellent Good Satisfactory Poor Very poor 5 4 3 2 1 Areas to consider (prompts) Appropriate skill set including statistical expertise Evaluation criteria Score Excellent Good Satisfactory Poor Very poor 5 4 3 2 1 Areas to consider (prompts) Evaluation criteria Score Clinical and/or scientific relevance and impact Score given Additional comments: Section 2 Governance and approvals Score given Additional comments: Section 3 Research team Score given Additional comments: Section 4 Score given Feasibility of question and research design Excellent Good Satisfactory Poor Very poor 5 4 3 2 1 Evaluation criteria Score Excellent Good Satisfactory Poor Very poor 5 4 3 2 1 Evaluation criteria Score Excellent Good Satisfactory Poor Very poor 5 4 3 2 1 Additional comments: Section 5 Areas to consider (prompts) Quality of statistical analysis plan (SAP) Score given Additional comments: Section 6 Areas to consider (prompts) Patient and public involvement Score given Additional comments: NICOR REVIEWER’S OVERALL COMMENTS: Reviewers name: Reviewer’s expertise: Date of review: Comments Recommend approval for application No Yes – without modifications Yes – with modifications State modifications/recommendations NICOR Data Access Application Evaluation Form Guidance notes Each section must score a 3 or above for consideration for approval A score of 2 indicates that NICOR advice for improvement and modification is required. Depending on how many sections this is relevant for will depend on whether a revised application submission is required. A score of 1 in any section in isolation will require NICOR advice and application revision and resubmission A score of 1 in more than 1 section may lead to the study being rejected at this submission.