Biologic Specimen and Data Repository Information Coordinating Center

The form templates are available here so that the requestor may become familiar with the information which will be requested on web request forms. The templates are not editable and cannot be used to submit a request. To request data and/or biospecimens from BioLINCC collections, please visit the Studies page.

Data Request Form

* = Required Field

Request Identifier

Request Name*

Create a nickname for your reference.

Requestor Information

Only Principal Investigators (i.e., Senior Investigators or other individuals with the authority to sign the RMDA for the research being proposed) may submit this request form. (See FAQ: What are the requirements for requesting study datasets?)

Name*

Note: field is populated from your profile, if information is missing/incorrect update your profile

Title

Institution*

Note: field is populated from your profile, if information is missing/incorrect update your profile

Email*

Note: field is populated from your profile, if information is missing/incorrect update your profile

Department

Address*

Note: field is populated from your profile, if information is missing/incorrect update your profile

Country*

Note: field is populated from your profile, if information is missing/incorrect update your profile

Phone

Note: field is populated from your profile, if information is missing/incorrect update your profile

Fax

Note: field is populated from your profile, if information is missing/incorrect update your profile

Website

Support Information

Institution type*

Non-Profit Organization

Commercial Organization

Academic

Number of years in scientific research

0-5

5-10

10+

Approximately how many years has the lead investigator been involved in scientific research?

Is funding currently available for this research?*

Yes

No

Primary Funding Source for this Research*

If funding is not yet available, please indicate anticipated primary funding source.

Extramural Award Type

Other Funding Type / Other Extramural Award Type

NIH FOA #

Other Funding Comments

Request Details

Study*

Resources from multiple studies may be requested via one request form using the above drop down menu.

Describe this request*

A brief overview of your research needs.

Design and analysis plan*

Include the participant inclusion/exclusion criteria, expected study visit periods, key analytic variables, primary and secondary outcome measure, follow-up period (if applicable), and intended statistical methods. Inadequately described requests may be deferred until a complete description is included.

Will the results be used for a commercial purpose?*

Yes

No - the results will not be used for a commercial purpose.

A "Yes" response defines this as a "Commercial Purpose" request.

Information Security: Please check the information security practices to be used*

Institute supported, controlled access server

Institute supported, password protected desktop computer

Encrypted, password protected laptop computer

Encrypted portable media (encrypted external hard drive, encrypted thumb drive)

Unencrypted portable media backup (CD, DVD, thumb drive) stored in locked file cabinet

Private (institutional) or commercial encrypted cloud

Study data must be maintained in a secure and controlled environment

Provide the name of the cloud provider (e.g. Amazon Web Services, Microsoft Azure, Google Cloud Platform), and briefly indicate how the cloud computing service will be used to carry out the proposed project (e.g. what tools will be used and how these tools relate to the project).

Check to affirm that access to the private or commercial encrypted cloud service will be granted only to those within the Principal Investigator's (PI) institution under the supervision of the PI.*

Comments