ACC Research Ethics
Committee Application
ACC Research Ethics Committee
To
From
Via
Date
Descriptive title
The ACC Research Ethics Committee meets on the first Wednesday of each month
except January. Papers for the Ethics Committee must be in the hands of the
secretary by 10.00 am two weeks prior.
Instructions are highlighted yellow.
application.
Please delete these before you submit the
1.
Applicant Contact details
1.1
Name of Principal Investigator:
1.2
Address of Principal Investigator including email:
1.3
Name of Institution:
1.4
Funding agency:
1.5
If the research is funded, in part or in full, by ACC:

Name of sponsor within ACC:

Name of ACC Research contact:
Checklist: Please include (where appropriate):
Consent forms
Study information sheet
Letters to participants
Applications or correspondence with other
ethics committees
Any other relevant materials
ACC Research Ethics Committee Application
2.
Purpose of application
2.1
This section should be a clear and succinct statement that describes the purpose of
the application and should be no longer than five sentences.
3.
Background
Use sub headings to separate topics
3.1
This section should state clearly what the proposal covers, how the proposal arose
and key decisions already taken. Include any previous research undertaken in this
area and the outcomes of the research.
4.
Description of study for which ethical approval is requested:
(Please keep this section short and succinct)
Aims
4.1
Outline the aims of the project
Methods and Design
4.2
Describe the methods and design (including details on sampling, stratification,
numbers, description of participants/clients, inclusion/exclusion criteria, locations,
settings etc)
Timelines
4.3
Project Timeline
Dissemination
4.4
How will the results be disseminated?
5.
Expected Outcomes
5.1
This section should briefly describe the main outcomes expected from the research
and describe how these outcomes are relevant to ACC. The benefit to ACC from the
research, if any, should be clearly stated.
6.
Ethics requirements
Relevant ethical issues
6.1
Briefly identify any relevant ethical issues and identify how these will be addressed.
(This may include details on, cultural issues, justification of case selection, the
characteristics of the clients, privacy, confidentiality, data security issues, how clients
will be contacted and how consent will be obtained. Include information on whether
ethics approval has been sought before for the study).
6.2
As a whole, this section should outline the ethical issues and the mitigation strategies
taken. As a guide, key issues are how the research may look from the participant’s
perspective (including how they will be recruited) and the flow of confidential data and
information.
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ACC Research Ethics Committee Application
7.
Data required
7.1
If ACC data is required for the study other than high level summary data, carefully
describe the fields required (eg: name of client, address). It is important to note
whether or not the data will include personal identifiers or any combination of fields
that might lead to the identification of an individual. Please also provide information
of the timeframes over which data is required (eg: all claims between 2000 and 2002)
and the date(s) on which the data is required.
8.
Consultation
8.1
Outline who, both within and outside ACC, has been consulted about the research.
This may include other researchers, users of research and sector stakeholders.
Please include both names and job titles. It is strongly recommended that researchers
discuss their research with an appropriate person in ACC.
9.
Contract details
9.1
Is the data request being done in partial fulfilment of a contract with ACC or other
research organisation? If so, please name the contract.
9.2
Name of ACC Group/Unit with whom contract is held.
Updated January 2016
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