Adapting Minds



AM_research


Mechanisms of self-regulation (project from ELTE University, Budapest, Hungary) GDPR.

Appendix #5: Permission to data processing

  I, as undersigned data subject,

 hereby expressly give my consent to the following data controller:

Eötvös Lorand University  (HU 1053 Budapest, Egyetem tér 1-3.)

 Clinical Psychology and Addiction........................ (name of the department)

Izabella Utca 46...................................................... (address of the department)

+ (36-1) 461-2600 / 5601........................................ (phone number)

 

to process

my following data (in the context of the research project “Mechanisms of Self-regulation”):

 

#1 Basic data:

- Name, e-mail address

- Gender

- Handedness

- Presence (by self-report) of a psychological/medical condition or disorder

- Medical contraindication for tDCS (presence of migraines/headaches, (metallic) implants, epilepsy, head trauma, pacemaker, skin problems, presence of psychological condition/disorder)

- Any adverse events

- Group assignment guess (control group / intervention group).

- Response regarding presence of discomfort

 

#2 Body Mass index:

- Data regarding weight and height

 

#3 Data from Specific Questionnaires:

- Self-report English language proficiency

- Short form Self-Regulation Questionnaire (SSRQ)

- The Mindful Attention Awareness Scale (MAAS)

- Simple Lifestyle Indicator Questionnaire (SLIQ)

- The Depression Anxiety Stress Scale (DASS21)

 

#4 Data from computer tasks:

- Adapted Stop Signal Task (SST).

- Visual Spatial Cueing Task

 

#5 Brain activity data

- Electrophysiological (brain-activity) data will be recorded throughout the experiment.

 

All personal data will be coded, and it will not be possible for anyone not involved in the project to trace back coded data to individual persons. The data will be used for the following purposes:

 

Main aim: elucidating the mechanism of self-regulation______________

Secondary aim: investigating the relationship between BMI and self-regulation________

 

Legal basis of the processing of my data: my consent, given with this statement.

 

Data processor:

-          H.N.Alexander Logemann, PhD    …… Principal Investigator

-          Izabella utca 46, Budapest...................... (address of the processor)

-          +36304454686........................................ (phone number)

 

The duration of my data processing: is according the Rules of Document Management at Eötvös Lorand University:

-          My data will be discarded after 10_______ years

 

My rights (in details bellow in Appendix):

1.     Transparent information, communication and modalities for the exercise of the rights of the data subject I can ask for information concerning my data, at any time;

2.     Right of access by the data subject I can access my data at any time;

3.     Right to erasure (‘right to be forgotten’), right to restriction of processingIf I have found a mistake, data controller will correct as soon as possible.

4.     Information to be provided where personal data have not been obtained from the data subject I will be informed if my data are forwarded to third party;

5.     Right to data portability (if data controller process my data on the basis of my consent/contract
the processing is carried out by automated means.
) – if I need, data controller will give me my data;

6.     Right to object -  I can object, at any time to processing of my personal data ;

7.     The right not to be subject to a decision based solely on automated processing, including profiling – it does not concerns me, nevertheless I can tell if still I am.;

8.     The right to legal remedy: in the case of breach of my rights, I can turn to the data protection officer, to the National Authority for Data Protection and Freedom of Information, or you can sue a claim to the court.

 

Data protection officer of the University:

Rector’s Cabinet

1053 Budapest, Ferenciek tere 6.

Tel.: +36-1-411-6500/2855

Email: strategia@rk.elte.hu

 

National Authority for Data Protection and Freedom of Information

1125 Budapest, Szilágyi Erzsébet fasor 22/c.

www.naih.hu

Tel.: +36-1-391-1400

 

The court:

I can sue for a claim according to my place of residence.

 

I hereby expressly declare that I have understood the information given above and in the Annex of this declaration, and I give my consent to the data processing with regard it.

 

 

 

 

………………………………………………………………………………………………………

location (site)                                        date                                        signature (participant)

 

(name):_________________________________

 

address (availability): ___________________________________

 

identification number according to the choice of the data subject (e.g. date and place of birth, number of ID

 

card): ______________________________________