This is an HTML version of an attachment to the Freedom of Information request 'Vaccine exemptions'.

Data Request Form 
Requesting Health statistics and data 
Where Health and Aged Care data is not available publicly, you can request data by filling in this 
form. The process and timeframes for each request can vary depending  on the type of data 
required and the complexity of data extraction. 
The release of Health statistices and data is bound by privacy, confidentiality and secrecy 
provisions in relevant legislation. 
Assessment of your data request will include the following: 

purpose - a specific research question or public benefit defined outcome has been identified
that can reasonably be expected to support improvement of the health or wellbeing of Australians 

anonymity - anonymity checks—to ensure data requested cannot identify an individual or
entity where consent is not given  

consent - any identified and identifiable information can only be provided with the valid
consent of the identified people or entities—for consent to be valid it must be free, 
informed, competent and current 

privacy compliance - the release of data must be in accordance with the purpose for which it
was collected 
If your request is approve it will be forwarded to a data extraction team. Our staff may contact 
you to check that the data extracted will meet your needs. 
If your request involves complex of customised extraction of data, you may be provided with an 
estimate of costs. 
Cost recovery for statistics and data requests 
The Commonwealth Government may charge a fee for requests for customised statistics and 
Any amount charged is based on the requirements of your request.  
Once the quote is accepted, we will extract the data in the agreed timeframes. 
In order to assist with our assessment please send with this form any other 
documentation for the project that you have such as: project outline, risk assessment, 
ethics approval etc

Media enquiries and FOI 
This form is to request data for performing analytics. Media requests should be made through the 
Media Centre .  FOI requests should be made through the FOI page . 
Government agencies that provide Australian health data: provides an easy way to find, access and reuse public data. 
If the data you require is not on, it may be available from of the following agencies, 
which have a wealth of data on health and other issues.  
Note: Please try to get your data from these agencies before submitting a request to the 
Department of Health. 
Department of Human Services (DHS): 
The DHS is responsible for social welfare, health and other payments and services. 
Information on how to obtain data on Australian Government health and welfare payment is 
available on the DHS website
Australian Bureau of Statistics (ABS): 
The ABS is Australia’s national statistical agency, providing trusted official statistics on a wide 
range of economic, social, population and environmental matters of importance to Australia. 
The ABS provides publicly available statistics about all aspects of Australia. They also provide 
information on the ABS microdata assets and access to ABS microdata can be requested through 
the Microdata Entry Page 
Australian Institute of Health and Welfare (AIHW): 
The AIHW is a major national agency set up by the Australian Government under the Australian 
Institute of Health and Welfare Act to provide reliable, regular and relevant information and 
statistics on Australia's health and welfare. 
Reports, analysis and data can be accessed or requested through their website
The Independent Hospital Pricing Authority (IHPA): 
IHPA's primary function is to enable Activity Based Funding for Australian public hospital services. 
IHPA does this by delivering an annual National Efficient Price (NEP) and National Efficient Cost 
(NEC). The NEP and NEC are a major determinant of the level of Commonwealth Government 
funding for public hospital services and provide a price signal or benchmark for the efficient cost of 
providing public hospital services. 
Information on IHPA's data holdings and instructions for applying for IHPA data can be found on 
their website 

Requestor Details
First name
Last name
Contact information
Telephone Number
Street Address
Postal Address
2. Please list the people who  will be using this data together with their relevant experience. If
they have an Australian Government security clearance, please state the level of clearance.
3. Will the data be used or disclosed for any purpose that is additional to or different from the
original request?


Project name
Proposed project start date
Proposed project end date
Please provide a brief description of the project you will be using this data for.

This section asks questions about how you intend to use the requested data.
4. What are your project objectives?
5. Please provide an overview of how the data you are requesting will assist your

6. Please list all collaborating partners, including those overseas (eg. universities,
industry partners, consultants, etc.)

This section asks questions about data linkage associated with the project
7. Does this project involve data linkage?
8. Which datasets are to be linked?
9. Who will be linking the data?
10. What data linkage methodology will you be using?

11. How is your project being funded?
Please provide details of both direct and indirect funding, both from within and outside 
12. Is this a consented study?
Please select only item
Please attach a copy of the consent form used.
13. Provide details of the ethics committee approval for this project particularly in regard
to the use of the requested data.

Please attach the ethics approval documentation and any documents you wish to include with the request. 

14. Are you willing to submit your project to the Department of Health, Department of
Human Services (DHS) or the Australian Institute of Health and Welfare (AIHW) ethics 
committee if deemed necessary?

Please select only one item
15. Does your project involve any human samples? eg blood, tissue, organs.
Please select only one item
16. Is this a clinical trial?
Please select only one item
If yes, provide your clinical trial number here
The Department of Health requires all clinical trials to be registered with the Australia New Zealand 
Clinical Trial Registry

17. Are you:
Please select all that apply
A resident of Australia
Employed by the Commonwealth public service
Employed by a health or welfare service provider
Employed by a state government public service
Researcher / academic
Politician/political advisor
Employed by a peak body or advocacy group
A student

18. Has the project hypothesis been tested against publicly available versions of the data
to demonstrate the validity of the research question?

Please select only one item
If yes, provide details (if not, why?)
19. Provide research methodology or analysis framework and protocols
Please include any relevant information on samples, proposed sample weighting and steps taken to avoid 
spontaneous recognition.
20. Provide details on the information to be published or released, or the related
educational resource being developed 

• Will the data be publicly released?
• What is the nature of the resource or publication?
• Who is the intended target audience?
• When is it proposed that the final report or resource will be completed?
• Is it proposed that the results will be published, and to whom will they be released?

21. What measures are in place to mitigate the risk of potential re-identification of
individuals or groups from the information to be published or released?

22. What type of data are you requesting?
Medicare Benefits Schedule (MBS)
Pharmaceutical Benefits Scheme (PBS)
Aged care
Private health insurance
Hospitals (public or private)
Therapeutic Goods Administration (TGA)
Health workforce
Mental health
Indigenous health
Population health
Other (provide details)
If other or multiple categories, provide details
23. What question(s) are you trying to answer from the data.
Please attach a copy of any documents you wish to include with this submission. Please ensure 
the file is in an accessible format. If you wish you may attach a mock-up of the table of data you 

24. Please describe the data set you are requesting, including details such as the years
you are requesting, and your preferred data format.

25. What level of detail are you requesting?
Note: the more graduated the data you request the more work will be required to process your 
request and the more cost will be involved.
Please select only one item
Unit Record Data
Primary Health Network (PHN)
Local Government Area (LGA)
Individual Hospitals
Statistical Area 2 (SA2)
Other (provide details)
If other or multiple categories, provide details here
26. Does this data request involve any identifiable data (direct names, addresses, dates of
birth, data provider numbers, etc.)

Please select only one item
If yes, what testing will you performing to prevent individuals being identified? What measures 
will you employ to keep identifying keys separate from sensitive data?
27. Does this data request involve de-identified versions of this data?
Please select only one item
If yes, what testing will you performing to prevent individuals being identified? What 
measures will you employ to keep identifying keys separate from sensitive data? (next page)

28. Where will you store and use the requested data? Please include details about IT
and building security, data security training, authorisations, logging of all accesses

29. Does the data you are requesting contain information on any of the following:
Please select all that apply
Drugs of addiction
Psychotropic drugs
Medical workforce
Bulk billing
Allied health
Highly Specialised Drugs (HSDs)
Linkage of PBS and MBS items
Derived major specialties
Mental health drugs
IVF/pregnancy related drugs
PBS Risk Share items
Under co-payment prescriptions
Safety net
Voluntary Indigenous Indicator (VII)
Low utilisation PBS and MBS items
Primary Health Networks (PHNs)

We may charge a fee for requests for customised statistics and data. 
The amount you will be charged is based on the requirements of your request. There may be no 
charge if publicly available data meets your needs. 
If your request is complex and involves extraction of data, you will be provided with a quote before 
any work is undertaken.
30. Invoicing details
Organisation name
Billing address
Contact name
Phone number
Contact email

Document Outline