Section 1: Your details

Name

Email

Telephone number

Organisation

Product, application or service name

Please also include version if relevant

Section 2: Your service/application

How many end users currently or will use your service/application? Select an option 0 to 100 101 to 1,000 1,001 to 5,000 5,001 to 10,000 10,001 +

Please provide further information about the number of end users (if required)

What type of data does or will your service/application reference?

• Public information, for example name, job titles, work location, honours and awards
• Sensitive information, for example health care or financial information
• Patient identifiable information, for example data of birth, race, religion, weight, treatment plans

Please provide further information about the type of data referenced (if required)

What methods do or will the majority of your users use to login?

• Smartcard
• Biometrics (please provide further detail below)
• Multifactor identification
• Username and password

Please provide further information about biometric or other forms of authentication

Which option best describes your service/application?

• Client server web application
• Desktop fat client
• Native application
• Single page application (please provide further detail below)
• Other (please provide further detail below)

Please provide further information about your service/application and organisation

Which of the these operating systems do you expect your users to be using?

• Android
• Windows
• iOS
• Linux
• System agnostic (please provide further information below)

Please provide further information about these operating systems, particularly if you have selected system agnostic

Select the level of service your users need Select an option Twenty four hours a day, seven days a week with no unplanned downtime Twenty four hours a day, seven days a week with some minimal unplanned downtime acceptable Office hours (8am to 6pm) excluding bank holidays and weekends with planned downtime

Which (if any) existing NHS Digital APIs have your users been assured by NHS Digital to use?

Please explain any measurable benefits you offer to health and social care providers

Provide evidence where possible, for example time/cost saving, experience improvement

Please explain the benefits to end users of your service or application

For example improvements to patient experience or user satisfaction

Why does your service/application require NHS CIS2? How are you solving the problem of assuring and authenticating your users currently?