# AI Use Case Registration Form

**Date submitted:** [Date]

## Basic Information

| Field | Response |
|-------|----------|
| **Submitter name and role** | |
| **Business unit / team** | |
| **System or project name** | |
| **Brief description** | |
| **AI technique** | [ ] Machine learning [ ] Deep learning [ ] Generative AI [ ] Rule-based [ ] Other: ___ |
| **Development approach** | [ ] Built in-house [ ] Vendor-procured [ ] Open-source [ ] SaaS |

## Stakeholder Impact

| Question | Response |
|----------|----------|
| Who are the primary users? | |
| Who is affected by the system's outputs? | |
| What decisions does the system support or automate? | |
| What happens if the system is wrong? | |

## Data

| Question | Response |
|----------|----------|
| What data does the system use? | |
| Does the data include personal information? | [ ] Yes [ ] No |
| Does the data include sensitive categories? | [ ] Health [ ] Financial [ ] Biometric [ ] Children [ ] Other: ___ |
| How is the data collected and with what consent? | |

## Risk Indicators

| Question | Yes / No |
|----------|----------|
| Could this system affect someone's access to services, benefits, or opportunities? | |
| Could this system cause physical, financial, or reputational harm? | |
| Does this system operate in a regulated domain? | |
| Is human review of the system's outputs required or feasible? | |
| Is this a novel use of AI for the organization? | |

## Requested Timeline

| Field | Response |
|-------|----------|
| **Target deployment date** | |
| **Regulatory or contractual deadline?** | [ ] Yes: ___ [ ] No |

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**For triage use (do not fill in):**

| Field | Response |
|-------|----------|
| **Risk tier assigned** | [ ] Tier 1 [ ] Tier 2 [ ] Tier 3 [ ] Tier 4 |
| **Assigned reviewer** | |
| **Date triaged** | |