Preliminary Quote Request The Data Linkage Branch (DLB) usually charges for linkage, geocoding or extraction requests that fall outside core activities. Funds derived from these charges assist in supporting staff and equipment used for the on-going development of the linkage system. The charges depend on the size and complexity of the linkage or extraction tasks involved. For extractions, the cost depends on the number of datasets, number of years and number of individuals in the data extract. A quote for linkage will usually be provided with feedback to a draft application for data, however if you would like a quote before applying for a grant or to scope your project, please complete this form and email it to DataServices@health.wa.gov.au. For queries about charging please contact the DLB Program Manager, Diana Rosman at diana.rosman@health.wa.gov.au . 1. PROJECT DESCRIPTION Please provide a brief description of the project: 2. CONTACT DETAILS Name: Organisation: Phone: Email: 3. REQUEST DETAILS NEW LINKAGES How many records will be provided for linkage? Will Unique Medical Record Numbers (UMRNs) be provided in the data for linkage? Does this data need to be geocoded? COHORT SELECTION If your cohort is be selected from one or more linked data collections, please provide a brief description of how it will be selected, including the datasets and year range: Approximately how many people do you expect to be in the cohort? COMPARISON GROUP/S SELECTION Do you require a comparison group/s? If so, please provide a brief description of how it will be selected, including the datasets and year range: Data Linkage Branch Request for Quote Form October 2013 1 Approximately how many people do you expect to be in the comparison group? If matching is required, please describe the fields to be matched on: FAMILY CONNECTIONS Do you need genealogical data for the cohort? If so, please provide a brief description of what is required: Approximately how many people do you expect to be in the family group/s? DATA EXTRACTION Please provide a brief description of what data you require: How many datasets do you wish to access for the cohort? What is the longest period of data you wish to access for the cohort? How many datasets do you wish to access for the comparison group/s? What is the longest period of data you wish to access for the comparison group/s? How many datasets do you wish to access for the family group/s? What is the longest period of data you wish to access for the family group/s? 5. COMMENTS 6. QUOTE DETAILS This section is to be completed by a staff member of the Data Linkage Branch. Linkage Cost: Extraction Cost (cohort): Comparison Group selection Cost: Extraction Cost (comparison group): Family Connections Cost: Other costs: Total: Plus GST: Data Linkage Branch Request for Quote Form October 2013 2