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C. Physical security: In addition to electronic security, the devices on which the dataset have <br />been copied must be physically secured to prevent theft of the device. Describe below the <br />physical security measure in place for each device. <br />If co -investigators at different institutions from the PI will also have physical control of <br />the data, complete the table for each such co -investigator's institution and describe how <br />data will be securely transferred between institutions. <br />Y. Receiving Institution <br />A. Identify the Receiving Institution, as that term is described in the Guidelines. <br />B. Provide the IRB assurance number. <br />C. Describe your Institution in detail. What kind of work does it do? Include the type of <br />organization, its profit/non-profit status, and primary sources of revenue. <br />D. Provide evidence in an attachment that your institution is registered with the U.S. <br />Office for Human Research Protections. <br />E. Describe your plans to obtain IRB approval for this study using the NCRPCD data. <br />F. Describe your Institution's experience in overseeing the use of sensitive research data <br />by its staff. Please give specific examples. <br />G. Describe any known breaches of sensitive research data by your organization and the <br />steps taken to remedy the breach. <br />23 <br />Location of Device <br />Description of physical security <br />ID <br />Indicate building <br />name and office <br />Examples are offices are locked when unoccupied; storage in secure <br />number <br />cabinets when the device is not in use; and monitored access to the <br />building where the data are stored. <br />1 <br />2 <br />3 <br />4 <br />Y. Receiving Institution <br />A. Identify the Receiving Institution, as that term is described in the Guidelines. <br />B. Provide the IRB assurance number. <br />C. Describe your Institution in detail. What kind of work does it do? Include the type of <br />organization, its profit/non-profit status, and primary sources of revenue. <br />D. Provide evidence in an attachment that your institution is registered with the U.S. <br />Office for Human Research Protections. <br />E. Describe your plans to obtain IRB approval for this study using the NCRPCD data. <br />F. Describe your Institution's experience in overseeing the use of sensitive research data <br />by its staff. Please give specific examples. <br />G. Describe any known breaches of sensitive research data by your organization and the <br />steps taken to remedy the breach. <br />23 <br />