# License Requirements Checklist

| Form ID | FRM-LIC-001 |
|---------|-------------|
| Form Title | License Requirements Checklist |
| Version | 1.0 |
| Effective Date | [DATE] |

---

## Measure Information

| Field | Information |
|-------|-------------|
| Measure Name | |
| Version/Form | |
| Measure Type | ☐ PRO  ☐ ClinRO  ☐ ObsRO  ☐ PerfO |
| Purpose/Study | |
| Protocol Number | |

## Copyright Status

| Field | Response |
|-------|----------|
| Copyright Holder | |
| Copyright Holder Contact | |
| Website | |

### Copyright Classification

☐ **Public Domain**
- No copyright restrictions
- Free to use without permission
- No license required

☐ **Open Access with Attribution**
- Free to use
- Attribution required
- Specific citation format: _____________________

☐ **Proprietary - License Required**
- Paid license required
- License type needed: ☐ Academic  ☐ Commercial  ☐ Clinical
- Proceed to License Requirements section

☐ **Special Permission Required**
- Must contact copyright holder for permission
- Restrictions on use: _____________________

## License Requirements (if applicable)

### License Type Options

| License Type | Cost | Terms | Notes |
|--------------|------|-------|-------|
| Single Study | | | |
| Multi-Study | | | |
| Institutional | | | |
| Commercial | | | |

### Scope of Use

Number of Participants: _________

Study Sites/Locations: _________________________________________

Countries: ___________________________________________________

Study Duration: From __________ to __________

### Administration Mode

☐ Paper-based
☐ Electronic (eCOA)
  - Platform: _____________________
  - Additional fees for electronic use? ☐ Yes  ☐ No

### Translation Requirements

Languages needed: _____________________________________________

☐ Official translations available
☐ New translation required (see SOP-TRN-001)
☐ Translation included in license
☐ Translation requires additional fee

### Special Requirements/Restrictions

☐ Training/certification required for administrators
☐ Restrictions on modifications
☐ Requirements for result reporting to copyright holder
☐ Publication acknowledgment required
☐ Royalty fees for commercial use

Details: ________________________________________________________
________________________________________________________________
________________________________________________________________

## Action Items

| Action | Responsible | Target Date | Status |
|--------|-------------|-------------|--------|
| Contact copyright holder | | | |
| Obtain license application | | | |
| Complete application | | | |
| Legal review | | | |
| Obtain approval signatures | | | |
| Submit payment | | | |
| File executed license | | | |

## Documentation Checklist

☐ Copyright holder contact information verified
☐ License application obtained
☐ License terms reviewed
☐ Legal review completed (if required)
☐ Budget approved for license fees
☐ License application submitted
☐ License agreement received and executed
☐ Payment processed
☐ License filed in License Tracking Database (FRM-LIC-002)
☐ Project team notified of license status

## Notes/Additional Information

________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

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## Signatures

| Role | Name | Signature | Date |
|------|------|-----------|------|
| Completed By | | | |
| Reviewed By | | | |

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**Related Documents:**
- SOP-LIC-001: License Management for Proprietary Outcome Measures
- FRM-LIC-002: License Tracking Database
- SOP-VAL-001: Measure Selection and Validation