Annual Demographic and Mortality data
ERROR CORRECTION FORM FOR POPULATION DEMOGRAPHICS REPORTING FORM
Form: B      Version: 2      11.9.87		 FOR MDC USE ONLY
Seq.no:

Received:
A. Annual demographics data was reported on the attached form, with MDC Sequence Number |___|___|___|___|___|___|
B. MONICA Collaborating Centre name: Code:|___|___|
C. MONICA Reporting Unit name: Code:|___|___|
D. Calendar year for which information was provided: |___|___|___|___|
E. Date when Error Correction Form generated (day, month, year) |___|___||___|___||___|___|

The Monica Data Centre - Helsinki (MDC) has reviewed the information provided on the form identified above and noted the possible inconsistencies as indicated on the attached Population Demographics Reporting Form. Please review these carefully and record the appropriate changes below in accordance with the instructions for this Error Correction Form.

1. Centre code  |___|___| 2. Reporting Unit code  |___|___| 3. Calendar year  |___|___|___|___|
4.
Age group Number of   Total  
 Males  Females
25-29      
30-34      
35-39      
40-44      
45-49      
50-54      
55-59      
60-64      
65-69      
70-74      
Total      
5. Total number of inhabitants in the MONICA Reporting Unit _________________________ 7. Source of information  |___|
8. Person providing information: _________________________ Date: _____/_____/_____
day   month   year  
F. Person completing this error correction form ______________________________
Please type or print
______________________________
Signature 		Date: _____/_____/_____
day   month   year  
G. Comments or reservations about changes provided:

 

Instructions

This form was designed to facilitate communication between the MONICA Data Centre (MDC) and the MONICA Collaborating Centre (MCC) about possible errors or uncertainties for data previously reported by the MCC to the MDC on a Population Demographics Reporting Form. Its use is to be initiated by the MDC, which should complete parts A, B, C, D and E and attach the otherwise blank form to a copy of the Annual Population Demographics Reporting Form in question and then send both to the MCC. The MCC should then complete the Error Correction Form and return it to the MDC. The MCC should keep a copy of the completed Error Correction Form.

This form should be sent to the MCC, with items A, B, C, D and E completed, soon after the MDC receives the Annual Demographics Reporting Form from the MCC. It should be used only if there are questions about the information provided on the Reporting Form.

General instructions for completing form

This form can be completed either by typewriter or by hand. In either case the recorded information should be examined carefully for both correctness and legibility. Further, since it may be necessary to photocopy the form, perhaps several times, as a routine part of processing and providing reserve copies, it is essential that the recorded information be clear and dark. Hence, please use a dark ribbon if a typewriter is used, or a dark ball-point pen if the form is completed by hand.

This form includes blank spaces where you are to record the requested information. None of these spaces should be left blank. If you have no information to provide for a specific item, then so indicate according to the instructions for that item.

Specific instructions for each item

These instructions should be followed carefully when completing the indicated version of the Error Correction Form for the Population Demographics Reporting Form. Please ensure that the instructions are for the version of the form being completed. Specific instructions are listed by item below:

Items A, B, C, D, E

A. Annual demographics data was reported on the attached form, with MDC Sequence Number |___|___|___|___|___|___|
B. MONICA Collaborating Centre name: Code:|___|___|
C. MONICA Reporting Unit name: Code:|___|___|
D. Calendar year for which information was provided: |___|___|___|___|
E. Date when Error Correction Form generated (day, month, year) |___|___||___|___||___|___|

These five items are to be completed by the MONICA Data Centre. The information should be clearly written or typed and should agree with the official MONICA Collaborating Centre and Reporting Unit names and code numbers (see Part I, Appendix 2). (The MDC Sequence Number is assigned and used by the MDC only.)

The MDC should ensure that a clear copy of the appropriate Population Demographics Reporting Form is securely attached and that the questions about the information recorded on the Reporting Form are clearly and unambiguously identified and described.

The Monica Data Centre - Helsinki (MDC) has reviewed the information provided on the form identified above and noted the possible inconsistencies as indicated on the attached Population Demographics Reporting Form. Please review these carefully and record the appropriate changes below in accordance with the instructions for this Error Correction Form.

1. Centre code  |___|___| 2. Reporting Unit code  |___|___| 3. Calendar year  |___|___|___|___|
4.
Age group Number of   Total  
 Males  Females
25-29      
30-34      
35-39      
40-44      
45-49      
50-54      
55-59      
60-64      
65-69      
70-74      
Total      
5. Total number of inhabitants in the MONICA Reporting Unit _________________________ 7. Source of information  |___|
8. Person providing information: _________________________ Date: _____/_____/_____
day   month   year  

The section of the form represented above is to be used by the MCC to indicate changes that should be made to the information as originally provided on the Reporting Form. No item should be left blank. The MDC will circle the questionable items on the Population Demographics Reporting Form and will comment as to why the items where thought to be incorrect.

For each item questioned by the MDC, print or type in the space provided the revised information. For those items not questioned or for which no new information is available, place an "X" in the appropriate space. If the value questioned by the MDC is correct as originally reported, that is, if the value questioned by the MDC is correct and should not be changed, so indicate by writing "OK" in or next to the space provided.

An example of a Reporting Form as it might be received and a completed Error Correction Form are provided at the end of these instructions.

Item F

F. Person completing this error correction form ______________________________
Please type or print
______________________________
Signature 		Date: _____/_____/_____
day   month   year  

Type or print the name of the person completing this form and the date completed in the spaces provided. Note that this form is to be completed by the MONICA Collaborating Centre Principal Investigator, or his or her designate.

Item G

G. Comments or reservations about changes provided:

Type or print any reservations or comments about the data that may be helpful to the MDC in understanding the changes provided. Attach additional sheets if necessary.

An example of the form as the MCC receives it:

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An example of the marked Population Demographics Reporting Form enclosed to the error correction form, as the MCC receives it:

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An example of a completed form:

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