3.7 KiB
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
Signatures
| Role | Name | Signature | Date |
|---|---|---|---|
| Completed By | |||
| Reviewed By |
Related Documents:
- SOP-LIC-001: License Management for Proprietary Outcome Measures
- FRM-LIC-002: License Tracking Database
- SOP-VAL-001: Measure Selection and Validation