ROCS Intake

Please provide a short nickname for this project:*

We will use this name when communicating with our team members so we know which study we're talking about. This does not need to be an official IRB or publication title, but something that describes the gist of the study.

Have you already worked on or discussed this project/research with a ROCS team member?

YesNo

Which ROCS team member is familiar with your project?

What kind of support are you requesting? (Check all that apply)

Project Planning (proposals, grant writing, protocol development...)Regulatory Support (HSR/IRB submission, DUA, amendments...)Coordinator Support (recruitment, consenting, gift cards, transitional PRA...)Data Collection (REDCap build, chart review, SlicerDicer, surveys/interviews...)Biostatistician (analysis plan, power calculation, data analysis, consult...)Other

What phase of development is your project currently in?

Just an Idea/ProposalProtocol/Grant Development (working on study design, funding)Research Start-Up (IRB & other regulatory approvals, pre-enrollment)Study Operations (study is opened, ready for enrollment & collecting data)Data Analysis (data collection is completed or ready for interim analysis)Deliverables (manuscript, abstract, or presentation of results)Other

Are you requesting support for the current phase of development in your project?

YesNo

Please explain:

Is this for a grant submission?

YesNo

Name of grant agency

Grant submission due date

Identify the type of Research Start-Up Support you are requesting (Check all that apply)

REDCap/Qualtrics development (database, survey)HSR portal/COMIRB submissionConsent/Assent form developmentEpic Use Plan (setting up study in Epic)OnCore setup (prospective studies)Data agreement (DUA)Other regulatory approvalsOther study materials (i.e., flyer, information sheet, recruitment letter)Other

Identify the type of support requested (Check all that apply)

Data abstraction (chart review, SlicerDicer)REDCap Design/ManagementSubject recruitment and/or enrollment (consent) supportStudy subject payment program (gift cards)Qualitative interview with study participantsEpic/OnCore/other study documentationResearch Study Visits (scheduling, surveys, sample processing)Transitional PRA support or trainingOther

Do you currently have coordinator support within your department / division?

YesNo

Reason for requesting coordinator support

(no coordinator, limited coordinator FTE available)

Estimated length of time commitment

(number of weeks/months)

Estimated number of hours a week

Identify the type of Biostatistical Support requested (Check all that apply)

Is the analysis for an abstract or manuscript?

AbstractManuscriptNo / Unsure

Submission source (i.e., name of conference, society, journal, etc)

Submission due date

Please note that we may need up to 2 business days to respond to your request. For biostatistical analyses, we require a minimum of 4 weeks from the time we receive your data to the time we are able to provide a complete analysis. Depending on the developmental stage of your project, we may require additional information from your team before we can move forward with your project.

Does this project collect new data (i.e., primary data) or does it utilize previously collected data (i.e., secondary data)?

New data collection (prospective data)Secondary data

Select one

One time (cross-sectional design)Overtime (longitudinal design)

Select one

Data collected as part of a previous studyChart review from medical recordNational databaseOther

Have you already collected the data needed for analysis?

YesNo

Do you have an approved IRB Protocol?

YesNo

IRB Number

Do you have a deadline in mind?

Date

Flexible deadlineAbsolute deadline

Please clarify the reasons this deadline must be absolute rather than flexible.*

Please briefly summarize (5 sentences or less) your project/idea and how ROCS can support your project:

Please define any acronyms you use in your description:

Is there anything we should know before we schedule your intake (other deadlines, funding needs, staffing needs, publication goals, etc)?

Please upload any protocol or project documents, if you have them (protocol, abstract, manuscript) **do not upload any data with PHI**

Research Support Intake Form