CCS Reading Center Data Submission Form

Name of institution or lab generating data

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MonthlySemi-AnnuallyAnnually (at end of study visit)

NoneTo be used only if primary investigator is contacted/offered co-authorship (e.g. for R01 data)To be used only after publication of initial manuscriptOther

We understand that MWCCS data collected cannot be used for any commercial use and by checking here we commit that no MWCCS data will be used commercially.We understand that MWCCS data collected may not be maintained by our reading center and commit that once the study is completed, all QA completed and data delivered to the DACC, data records at the reading center will be deleted.We agree to provide this data in a timely way to the MWCCS DACC as specified in the submitted planWe agree to provide a data dictionary or codebook for the data we send the DACC that includes: variables, clear variable labels/descriptions in language investigators can understand and allowed values and ranges for each variable.We understand that noncompliance with this plan or the above agreements may affect reading center funding and investigator ability to have future MWCCS collaboration

Reading Center/Data Repository Data Submission

Section A: Study Overview & Contact Information

Section B: Study Design

Section C: Data Transfer