Specimen and Data Request Form

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.

Specimen and Data Request Form

* = Required Field

Request Identifier

Request Name*

Create a nickname for your reference.

Requestor Information

Name*

Title

Institution*

Email*

Department

Address*

Phone

Fax

Website

Support Information

Request Details

Study*

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

Describe this request, including a summary of the rationale, main hypothesis and proposed research aims*

A brief overview of your research needs.

Specimen requirements

Describe any additional requirements pertaining to the biospecimens themselves, such as anticoagulant used, additives, preservatives, etc.

Participant characteristics

Describe the characteristics of the participants to be searched for available specimens. Criteria might include gender, age, disease status, genotype, etc. Be as specific as possible.

Requested study visit(s), if applicable

Only applicable for studies that have more than one specimen draw point. If any visit is acceptable, please indicate so. Refer to the "Available Biospecimens" tables on each study description page for more information regarding the available visits for each material type. If more than one visit is requested, please indicate if you can accept participants that have specimens available from at least one, but not all of the requested visits.

Number of Participants

Approximate count of participants required for your study. This may be the same as the number of specimens if only one draw and material type is needed per participant.

Number of Specimens

Approximate count of specimens required for your study. This may be more than the number of participants if more than one draw and/or material type is needed per participant.

Material type

Minimum volume (or mass if requesting DNA)

Please include units.

Optimum volume (or mass if requesting DNA)

Please include units.

Analyte(s) or parameter(s) to be tested*

Describe the assay(s) to be performed and include any test volume requirements.

Type of assay(s)/ platform(s) to be used*

Describe the assay kit(s)/platform(s) to be used, if applicable.

Rationale for number of biospecimens requested, including power calculations, and describe the use of covariates, if applicable*

Also describe your intended use of covariates from study datasets, if applicable.

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.

Original Study Investigator?*

Yes

Were you an investigator with the original (parent) study(ies) referenced in this 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).

<b>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.*</b>

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