The code block below illustrates how one might use # and // as comments in your logic and calculations.

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The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

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This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

LITs8XoyPhodKLYPpZXAhTYty7kSXJWWQfZKy7HUMiSDHXjIUPP6oQLaRsgqSv4NzJtYuAEj9sgvpbgdX54GvGY8LPU5j9RXQMssidMcSCyhHgZZrhZKwV52th

Big Distribution Request Form v2

Returning?

A A A

!!! BEFORE starting the application, the PI should either use TriNetX to identify case and control groups for their study (share with Lokesh Chinthala (lchintha@uthsc.edu)) or request a preliminary list of samples and genomic data from Enza Colonna (vcolonna@uthsc.edu ) or Akram Mohammed (amoham18@uthsc.edu). Please see the BIG sample request FAQ page for details.

Thank you!

Does the PI have a faculty appointment at UTHSC?

* must provide value

Yes

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If no, please contact Robert Davis, MD, MPH for further assistance before proceeding: rdavis88@uthsc.edu

Applicant Name:

* must provide value

Principal Investigator name, if different from applicant:

* must provide value

Department:

* must provide value

Affiliation:

* must provide value

Campus:

* must provide value

Institution Location:

* must provide value

Email:

* must provide value

Phone:

* must provide value

PI's NIH Biosketch or CV

* must provide value

Upload file

Names and affiliations of project collaborators:

* must provide value

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Have you identified a research cohort in TriNetX(rEDW)?

* must provide value

Yes

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What is your request?

* must provide value

Data

Sample

Both

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Have you received and/or reviewed a preliminary list of available data in your cohort from BIG and confirmed the file types are appropriate?

* must provide value

Yes

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Have you received a preliminary list of available samples or data in your cohort from BIG?

* must provide value

Yes

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Have you confirmed that the concentrations and volumes of DNA sample in your submitted list meet your requirements for analysis?

* must provide value

Yes

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Have you obtained funding for your project?

* must provide value

Industry:

* must provide value

Previously Funded Grant:

* must provide value

Proposed Grant:

* must provide value

Institutional/ Departmental funds:

* must provide value

Letter or documentation verifying availability of funding from the department or outside sources.

* must provide value

Upload file

Project Title:

* must provide value

Project Narrative suitable for the general public:

* must provide value

Expand

Project Summary:

* must provide value

Expand

Research Approach and Analysis Methods:

* must provide value

Expand

Sample number and power estimate:

* must provide value

Expand

Research project peer review status:

* must provide value

NIH: completed /under review / planned

Departmental: completed /under review / planned

Other review: completed /under review / planned

If "other review", please describe funding agencies or institutions you plan to submit to for peer-review or provide explanation if no plans to do so:

* must provide value

Expand

Are there ethical concerns or issues that could be raised by the project?

* must provide value

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Estimated date (year/month) requested samples and/or data are needed:

* must provide value

Will any data be sent outside UTHSC?

* must provide value

If no, The sequenced data will be securely stored at the University of Tennessee, Secure Enclave, which is configured and compliant with the security requirements for storing and processing protected health information (PHI) as specified in written security plans following applicable HIPAA regulations and UT policies, including following the National Institute for Standards and Technology (NIST) Risk Management Framework and NIST 800 series publications. The UT Secure Enclave is configured to protect at-rest and in-transit data following the NIST Special Publication 800-53 Security and Privacy Controls for Information Systems and Organizations specifications, as specified by the DHHS HIPAA Security Rule Crosswalk to NIST Cybersecurity Framework document. The security plan sets the FIPS-199 information security categorization, the 17 control family policies, and the specification of 159 management, operational, and technical security controls, including but not limited to multi-factor authentication, encryption at rest and in transit, border protection (firewall), roles and separation of duties, least privilege, remote access control via VPN, continuous monitoring, security awareness training, and configuration management.

* must provide value

Name the secure facility that will store / analyze the data.

* must provide value

If yes, how will data be secured?

* must provide value

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Will any samples be sent outside UTHSC?

* must provide value

Name the secure facility that will store / analyze the samples.

* must provide value

If yes, how will samples be secured?

* must provide value

Expand

Quotation from Data Generation Service Provider (if using one).

Upload file

Today Date

* must provide value

M-D-Y

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