Data Application Form
**Please note** There are recent changes to the application process to obtain unit record data from Department of Health WA. Refer to the application process page for more information.
The application form is modular in nature. Please select the parts you require to tailor your application to your data request.
Expression of Interest
Researchers and data analysts wanting to obtain information from unit record data from one or more DOHWA data collections are now recommended to submit an Expression of Interest (EOI) before applying for institutional ethics and/or the DOHWA Human Research Ethics Committee (DOHWA HREC). This is also strongly suggested prior to applying for funding. The data managers meet and review EOIs on a fortnightly basis, feedback from the data managers for an EOI will be collated and sent via email and will take approximately two to three weeks.
The EOI should be made on an Application for Data (word, 156kB) form.
Also complete the data services required (see module 2) and the variable lists required (see module 3). Also provide the Cross-Jurisdictional module (if applicable) and any supporting documentation such as participant information sheets, consent forms, information about data collections required outside of DOHWA or other HREC approvals gained. Do not complete signature section or the Confidentiality Agreements with an EOI. Send your EOI with data services forms and variable lists to:
Module 1
Application for Data Form
After consulting with the relevant data managers your EOI can be amended and/or submitted, including all the necessary signatures as an Application for Data.
Your Application for Data (word, 156kB) request will be formally reviewed by the appropriate data managers in order to provide advice to the Director Generals delegate on release of data.
Finalise the data service forms required (see module 3) and the variable lists required (see module 4).
Module 2
Data Services
The type of data service request. Select the form required and complete. If more than one type i.e. linkage and extraction, then complete both forms.
Linkage (word, 38kB)
Extraction (word, 83kB)
Geocoding (word, 34kB)
Sample Selection (word, 34kB)
Attach your data service form(s) to the EOI or Application for Data.
Module 3
Variable lists for data collections
The variables required from the requested datasets. ONLY complete the forms for the data that is required.
Birth (word, 88kB)
Cancer (word, 59kB)
Electoral Roll (word, 50kB)
Emergency (word, 76kB)
Mental Health (word, 112kB)
Midwives Notifications (word, 126kB)
Hospital Morbidity (word, 111kB)
Mortality (word, 103kB)
Attach your variable list(s) to the EOI or Application for Data. Variable lists for other datasets (e.g. Ambulance data) are available on request at the Expression of Interest stage.
Module 4
DOHWA Human Research Ethics Committee (HREC) approval
The application form, other associated documentation and requirements for ethical review by the DOHWA HREC can be found at the DOHWA HREC website.
For assistance with completing the requirements for DOHWA HREC approval please contact the HREC Executive Officer on +61 8 9222 4278 or at HREC@health.wa.gov.au
Important note:
All listed analysts accessing the unit record data must sign a Confidentiality Agreement/Acknowledgment for researchers or WA public sector employees. Please see the DOHWA HREC website for these forms.
All applicants applying to the DOHWA HREC in addition must provide a detailed research proposal/protocol to accompany their DOHWA Application for Data and DOHWA Application for Ethical Review.
A research proposal/protocol should provide a more detailed outline of the project, in terms of the purposes and objectives of the study, the study design and proposed use of the data and any potential benefits of the research.
Module 5
Application for Cross-Jurisdictional Data
Researchers and data analysts wanting to obtain Cross-Jurisdictional data should submit the form below with their Expression of Interest (EOI). Feedback regarding this request will be given along with feedback from the WA data managers. If you have questions regarding Cross-Jurisdictional data or would like to discuss your project prior to submitting an EOI please contact Diana Rosman at diana.rosman@health.wa.gov.au or on +61 8 9222 4261.
Application for Cross-Jurisdictional Data
Submission processes
Submission of your DOHWA Application for Data where DOHWA HREC approval is required.
Send 1 original and 14 copies of the following:
- DOHWA Application for Data form (including data services, variable lists & supporting documentation e.g. participant information sheets, consent forms & information about data collections required outside of DOHWA)
- DOHWA Application for Ethical Review
- Detailed research proposal/protocol (this is in addition to the brief outline included in section 3 of the DOHWA Application for Data form)
to the DOHWA HREC Executive Officer by the deadline date to be considered at the next meeting. See 2008 DOHWA HREC Meeting Schedule (word, 33kB) here.
IMPORTANT: In addition, each listed analyst on the project must sign a Confidentiality Agreement/Ackowledgement for Researchers or WA public sector employees. Each original signed copy of the Confidentiality Agreement/Acknowledgment for Researchers or WA public sector employees must be included with the above requirements and sent to the DOHWA HREC Executive Officer (14 copies are not required of each agreement/acknowledgment instead only the original copy for each analyst is required). Once signed by the DOHWA representative copies of the signed agreements will be returned to the Applicant.
Where other HREC approvals have been obtained please provide one copy of the current approval letter with your application package.
Please send applications in hard copy to:
HREC Executive Officer, Information Management & Reporting
Department of Health WA
1st Floor, C Block
189 Royal St, East Perth WA 6004.
NOTE: Please ensure the Indemnity forms (last page) on both the DOHWA Application for data and Application for Ethical Review has been read, understood and signed by the Institutional Officer authorised to provide the indemnity.
Submission of your Application for Data where DOHWA HREC approval not required.
Where an application for linkable data does not require DOHWA HREC approval (using existing links with non-personal data) then your completed DOHWA Application for Data form (including data services, variable lists & supporting documentation e.g. participant information sheets, consent forms & information about data collections required outside of DOHWA) must be submitted with all current ethics approval attached. Only one original copy is required.
IMPORTANT: In addition, each listed analyst on the project must sign a Confidentiality Agreement/Acknowledgement for Researchers or WA public sector employees. Each original signed copy of the Confidentiality Agreement/Ackowledgement for Researchers or WA public sector employees must be included with the DOHWA Application for Data Form. (14 copies are not required of each agreement/acknowledgment instead only the original copy for each analyst is required). Once signed by the DOHWA representative copies of the signed agreements will be returned to the Applicant.
Please send application in hard copy to:
Project Officer, Data Linkage Branch
Department of Health WA
1st Floor, C Block
189 Royal St, East Perth WA 6004
NOTE: Please ensure the Indemnity forms (last page) on the DOHWA Application for data has been read, understood and signed by the Institutional Officer authorised to provide the indemnity.