Attachment 9 OHSR-Review

OHSRP #12934

REQUEST FORM: OHSRP DETERMINATION FORSURVEYS, INTERVIEW PROCEDURES,
PROGRAM EVALUATION, EDUCATIONAL TESTING AND RESEARCH
4. Proposed start date: 9/1/2015

Proposed completion date : 2/1/2016

5. Specify the nature of the data: (select all that apply)
__ Interview procedure
X_ Survey
__ Educational Testing
__ Educational Research
__ Research on public benefit or service programs
__ Other, describe: __________________________________________
6. What kind of human data (e.g., private information, responses to questionnaires,
test results, recordings) will be collected in your research?
Responses to questionnaire
7. Will human data be? (select all that apply)
Collected Yes_X_ No__
Received
Yes__ No_X_
Sent
Yes__ No_X_
8. If receiving or sending, list the collaborating investigator(s):
Name
Institution/IC
Address/e-mail
FWA number*
________________________________________________________________________
9. Where are the subjects of this research activity located? (Provide a general
description or complete the institutional information below)
The participants in the survey are from institutions supported by NCI extramural
research grants.
Institution: _____________________

Contact Name: _______________________

Address: __________________________________ Phone: _______________________
10. Will NIH investigator(s) have direct contact or intervention with the subjects of
the study? (For example, by interviewing, surveying or recording the subjects?)
Yes_X_ No__
If yes, what is the age range of subjects involved in the research?
___ Children aged < 18 years
__X_ Adults aged > 18 years
11. Who will collect the data or information?
(a) ___ NIH Investigator
Page 2 of 3

REQUEST FORM: OHSRP DETERMINATION FORSURVEYS, INTERVIEW PROCEDURES,
PROGRAM EVALUATION, EDUCATIONAL TESTING AND RESEARCH
(b) ___ non-NIH Collaborator
(c) __X_ NIH Contractor
(d) ___ Other, specify__________________________________________
If b or c, will an Honest Broker or data use agreement be used? Yes__ No_X_
If yes, complete and attach the Honest Broker Assurance or data-use agreement to
this submission; e-mail ohsr_nih_ddir@od.nih.gov to request a form.
12. Select the best description that applies to the human data or information:
_X_ Data or information will not contain any identifiable information, nor can it be
linked to individual subjects by you or your collaborators.
__ Data or information will be recorded in such a manner that subjects can be
identified directly or through identifiers linked to the subjects
13. Per NIH guidance, are all conflicts of interest by NIH employees (sender or
receiver), if any, resolved? __X___Yes _____No**
*A Federalwide Assurance (FWA) is issued by the U.S. Department of Health and Human
Services (DHHS)/ Office of Human Research Protections (OHRP) to institutions which
receive Federal funds/support to conduct human subjects research. To search for the
FWA# for domestic or international institutions go to
http://ohrp.cit.nih.gov/search/fwasearch.aspx?styp=bsc
**If the answer is “No”, note that OHSRP will be unable to make a determination and
research may not proceed until all conflicts are resolved. For more information, see the
October 2011, A Guide to Preventing Financial and Non-Financial Conflict of Interest in
Human Subjects Research at NIH. For assistance review the list of Ethics Coordinators
and find the contact for your IC: http://ethics.od.nih.gov/coord.pdf

Page 3 of 3

Current Trainee Survey Sample Questions –Version #3

5/8/15
OMB # 0925-XXXX
Expiration Date: XX/XXXX

Physical Sciences - Oncology Centers Program Trainee Survey
Public reporting burden for this collection of information is estimated to range from 10 to 25 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a currently valid OMB control
number. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC
7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx). Do not return the completed form to this address.

The National Cancer Institute (NCI) Division of Cancer Biology (DCB) invites you to
participate in an online survey pertaining to the Physical Sciences – Oncology Center
(PS-OC) Program. Your participation is requested in order to evaluate the training
component of the Physical Sciences in Oncology (PSO) Initiative. Your candid responses
will be used evaluate to what extent the PS-OC program encouraged collaborative
science and the career development of trainees in the field of physical sciences oncology.
All information obtained will be kept secure, to the extent provided by law. You may
start and stop the survey at your convenience. There are no risks to participating in this
survey and you understand there are no direct benefits to you for participating in the
survey, however it provides us the feedback that will be used to evaluate Phase I of the
PS-OC Program.
Thanks in advance for your participation. We greatly appreciate your time and
assistance.
1.
How long have you been a member of the PS-OC program?
☐Less than a year
☐1 year
☐2 years
☐3 years
☐4 years
☐5 years
2.

How have you participated as a member of the PS-OC? Check all that apply.

☐Performed research funded by the PS-OC
☐Participated in PS-OC courses
☐Attended a PS-OC Annual Meeting
1

Current Trainee Survey Sample Questions –Version #3

5/8/15

☐Attended a PS-OC Site Visit
☐Attended PS-OC workshops
☐Attended PS-OC boot camps
☐Attended PS-OC seminars
☐Other: Please describe: _____________________________________________
3.

Please select your current research title. Check only one.

☐Undergraduate student
☐Graduate student
☐Postdoc
☐Medical student
☐Resident
☐Other: Please describe: _____________________________________________
4.

How often do you interact with your PS-OC mentor?

☐One initial meeting only
☐Every 6 months
☐Every 3 months
☐Monthly
☐Weekly
☐Several times per week
☐Daily
5.
How would you define your scientific area of expertise BEFORE you were part of
the PS-OC program compared to now?

Physical Scientist
Cancer Biologist/Oncologist
Trans-disciplinary Researcher
Other: Please Define

Your field
BEFORE
PS-OC

Your field
now

2

Current Trainee Survey Sample Questions –Version #3

6.

There are a variety of different types of scientists involved in the PS-OC program.
Please identify the scientific areas for each of the following:

Physical Scientist
Cancer Biologist/Oncologist
Trans-disciplinary Researcher
Other: Please Define

7.

5/8/15

Your PS-OC
mentor’s field
of training and
expertise

The types of
scientists you
collaborate with
currently

Did the PS-OC program have a positive impact on any of the following?
Very High
Impact

Career development
Learning new skills
Gaining a new mentor
New collaborations with
professionals in my field
New collaborations with
professionals in other fields
Opening access to new
equipment/technology

8.

The types of
scientists
you would like to
collaborate with
in the future

Moderate
Impact

No Impact
at All

5
5
5

4
4
4

3
3
3

2
2
2

1
1
1

5

4

3

2

1

5

4

3

2

1

5

4

3

2

1

Based on your familiarity with the program and your personal experiences, how
well is the young investigator trans-network process achieving the following
goals?

Increasing collaborations among
centers in general
Increasing
discussions/collaborations
between young investigators
Advancing the convergence of
physical science and oncology in
cancer research
Making advances in cancer
research

Extremely
Well
5

4

Moderately
Well
3

2

Not at All
Well
1

5

4

3

2

1

5

4

3

2

1

5

4

3

2

1

3

Current Trainee Survey Sample Questions –Version #3

9.
☐Yes
☐No

5/8/15

Did you, at any point as a trainee, participate in a student exchange or otherwise
worked in another PS-OC investigator’s lab?

9a. If yes, How many exchanges or other PS-OC investigator’s lab did you
participate in?
☐1
☐2
☐3
☐4
☐5+
9b. Overall, how useful were these exchanges?
Extremely
Useful

Usefulness of student exchanges

10.

5

4

Moderately
Useful
3

Not at All
Useful
2

1

Do you plan to conduct research in the field of physical sciences – oncology in
the future?

☐Yes
☐No
☐Maybe/Unsure

Please explain why or why not:
11.

Overall, how would you evaluate the overall quality of your PS-OC supported
collaborations in the following areas:

Excellent

Fair

Poor

Scientific Impact

5

4

3

2

1

Productivity
Rewarding to all parties involved
equally
Communication among
collaborators
Ability to utilize the strengths of
different researchers involved
Enabling you to reach your own
research milestones faster

5

4

3

2

1

5

4

3

2

1

5

4

3

2

1

5

4

3

2

1

5

4

3

2

1

4

Current Trainee Survey Sample Questions –Version #3

5/8/15

12.
What difficulties, if any, have you experienced during your trans-disciplinary
collaborations in the PS-OC program? Please rate the severity of these difficulties on a
scale of 1 to 5 where 1 indicates that the issue did not impact the outcome(s) of the
collaboration and 5 indicates that the issue severely impacted the collaboration.

Members prioritized their personal
goals before the overall team goal
Difficulties in sharing data
The team members discuss issues
only at a broad level
Difficulties in sharing supplies, cells,
tissue or equipment
Responsibilities, roles, and
expectations were not clear
Difficulties in organizing travel
Team members became competitive with
one another
Difficulties in communication across the
scientific disciplines
Lack of funds
Power struggles
Sharing credit
The team did not meet regularly
The team did not establish trust
There is no reward structure at my
institution for collaborations
Trouble identifying additional team
members to help
Lack of clear vision or goals
No agreement on the primary
spokesperson

Yes, I
experienced
this

1=no impact
5=severe impact
1

2

3

4

5

☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐

5

Current Trainee Survey Sample Questions –Version #3

13.

5/8/15

Please answer the following questions with the approximate number of
investigators (i.e., faculty level researchers).
0

How many PS-OC investigators
within your Center did you work
with prior to the start of the PSOC program?
How many PS-OC investigators
within your Center do you work
with now?
How many of these new
collaborations would have
started without PS-OC program
funding
How many do you anticipate will
continue on after you leave PSOC?

14.

1-4

5-10

11-15

16+

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

From your perspective, please evaluate the extent to which the PS-OC program
has been successful in the following areas.

Improving leadership skills in
heading a trans-disciplinary study
Mentoring junior faculty in
leading and participating in a
trans-disciplinary study
Increasing the discussion about
team science and collaborations
at your institution
Developing better policies to
review and reward the team
science at your institution

Excellent
5

Don’t
Know

4

Fair
3

2

Poor
1

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

DK

6

Current Trainee Survey Sample Questions –Version #3

15.

5/8/15

From your perspective, please evaluate the extent to which the PS-OC program
has been successful in reaching the following program goals.

Form trans-disciplinary teams
focused on establishing physical
sciences-centric themes in cancer
research
Build a collaborative transdiscipline research sharing
network
Promote collaboration by PS-OC
researchers across the PS-OC
network
Educate trans-disciplinary
scientists that pursue careers in
the field of physical sciences in
oncology
Promote collaboration by PS-OC
researchers beyond the PS-OC
network
Form new physical sciences in
oncology programs at universities
or institutions
Test dogma-challenging
hypothesis or cancer initiation
and progression
Bring new types of scientists to
cancer research
Generate new datasets in cancer
research
Generate new knowledge in
cancer research

Excellent
5

Don’t
Know

4

Fair
3

2

Poor
1

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

DK

16. Please provide any additional comments that you would like to share about the
convergence of physical sciences in oncology or the PS-OC program.

7

Former Trainee Survey Sample Questions –Version #3

5/8/15
OMB # 0925-XXXX
Expiration Date: XX/XXXX

Physical Sciences - Oncology Centers Program Former Trainee Survey
Public reporting burden for this collection of information is estimated to range from 10 to 25 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a currently valid OMB control
number. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC
7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx). Do not return the completed form to this address.

The National Cancer Institute (NCI) Division of Cancer Biology (DCB) invites you to
participate in an online survey pertaining to the Physical Sciences – Oncology Center
(PS-OC) Program. Your participation is requested in order to evaluate the training
component of the Physical Sciences in Oncology (PSO) Initiative. Your candid responses
will be used evaluate to what extent the PS-OC program encouraged collaborative
science and the career development of trainees in the field of physical sciences oncology.
All information obtained will be kept secure, to the extent provided by law. You may
start and stop the survey at your convenience. There are no risks to participating in this
survey and you understand there are no direct benefits to you for participating in the
survey, however it provides us the feedback that will be used to evaluate Phase I of the
PS-OC Program.
Thanks in advance for your participation. We greatly appreciate your time and
assistance.

1.
How many years were you an active member of the PS-OC program?
☐Less than a year
☐1 year
☐2 years
☐3 years
☐4 years
☐5 years
2.
How long ago were you a trainee with PS-OC?
☐Less than a year ago
☐About 1 year ago
1

Former Trainee Survey Sample Questions –Version #3

5/8/15

☐About 2 years ago
☐About 3 years ago
☐About 4 years ago
☐About 5 years ago
☐Not sure
3.
Please select your current research title. Check only one.
☐Undergraduate student
☐Graduate student
☐Postdoc
☐Medical student
☐Resident
☐Other: Please describe: _____________________________________________

4.

How did you previously participate as a member of the PS-OC? Check all that
apply.
☐Performed research funded by the PS-OC
☐Participated in PS-OC courses
☐Attended a PS-OC Annual Meeting
☐Attended a PS-OC Site Visit
☐Attended PS-OC workshops
☐Attended PS-OC boot camps
☐Attended PS-OC seminars
☐Other: Please describe: _____________________________________________

5.

To the best of your knowledge, how often did you interact with your PS-OC
mentor? Please include all interactions in your response, please including faceto-face meetings, emails, phone calls, instant messaging and other digital forms
of contact, etc.
☐Never
☐One initial meeting only
☐Every 6 months
☐Every 3 months
☐Monthly
☐Weekly
☐Several times per week
☐Daily
6.

Did you continue to interact with your PS-OC mentor after leaving PS-OC?
2

Former Trainee Survey Sample Questions –Version #3

☐Yes
☐No

7.

5/8/15

6a. If yes, is that relationship still ongoing today?
☐Yes
☐No
How would you define your scientific area of expertise BEFORE you were part of
the PS-OC program compared to now?
Your field
BEFORE
PS-OC

Physical Scientist
Cancer Biologist/Oncologist
Trans-disciplinary Researcher
Other: Please Define

8.

There are a variety of different types of scientists involved in the PS-OC program.
Please identify the scientific areas for each of the following:

Physical Scientist
Cancer Biologist/Oncologist
Trans-disciplinary Researcher
Other: Please Define

9.

Your field
now

Your PS-OC
mentor’s field
of training and
expertise

The types of
scientists you
collaborate with
currently

The types of
scientists
you would like to
collaborate with
in the future

Did the PS-OC program have a positive impact on any of the following?
Very High
Impact

Moderate
Impact

No Impact
at All

Career development

5

4

3

2

1

Learning new skills

5

4

3

2

1

Gaining a new mentor
New collaborations with
professionals in my field
New collaborations with
professionals in other fields
Opening access to new
equipment/technology

5

4

3

2

1

5

4

3

2

1

5

4

3

2

1

5

4

3

2

1

3

Former Trainee Survey Sample Questions –Version #3

10.

Based on your familiarity with the program and your personal experiences, how
well did the young investigator trans-network process achieve the following
goals?

Increasing collaborations
among centers in general
Increasing
discussions/collaborations
between young investigators
Advancing the convergence of
physical science and oncology
in cancer research
Making advances in cancer
research

11.
☐Yes
☐No

5/8/15

Extremely
Well
5

4

Moderately
Well
3

2

Not at All
Well
1

Don’t
Know
DK

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

Did you, at any point as a trainee, participate in a student exchange or otherwise
worked in another PS-OC investigator’s lab?

4

Former Trainee Survey Sample Questions –Version #3

5/8/15

11a. If yes, How many exchanges or other PS-OC investigator’s lab did you
participate in?
☐1
☐2
☐3
☐4
☐5+
11b. Overall, how useful were these exchanges?

Usefulness of student exchanges

12.

Extremely
Useful
5

4

Moderately
Useful
3

2

Not at All
Useful
1

Are you currently conducting research in the field of physical sciences –
oncology?

☐Yes
☐No
If yes, please briefly describe that research:
13.

Do you plan to conduct research in the field of physical sciences – oncology in
the future?

☐Yes
☐No
☐Maybe/Unsure

Please explain why or why not:
14. Have you maintained any of your PS-OC collaborations into your current research?
☐Yes
☐No
Why or why not?
15. Have you started any new trans-disciplinary collaborations since leaving PS-OC?
☐Yes
☐No

5

Former Trainee Survey Sample Questions –Version #3

16.

5/8/15

Looking back, how would you evaluate the overall quality of your previous PS-OC
supported collaborations in the following areas:
Excellent

Fair

Poor

Scientific Impact
Productivity

5
5

4
4

3
3

2
2

1
1

Rewarding to all parties involved
equally
Communication among
collaborators
Ability to utilize the strengths of
different researchers involved
Enabling you to reach your own
research milestones faster

5

4

3

2

1

5

4

3

2

1

5

4

3

2

1

5

4

3

2

1

17.

How would you evaluate the overall quality of your current professional
collaborations in the following areas:

Scientific Impact
Productivity
Rewarding to all parties involved
equally
Communication among
collaborators
Ability to utilize the strengths of
different researchers involved
Enabling you to reach your own
research milestones faster

Excellent
5
5

4
4

Fair
3
3

2
2

Poor
1
1

5

4

3

2

1

5

4

3

2

1

5

4

3

2

1

5

4

3

2

1

6

Former Trainee Survey Sample Questions –Version #3

5/8/15

18.
What difficulties, if any, did you experience during your trans-disciplinary
collaborations in the PS-OC program? Please rate the severity of these difficulties on a
scale of 1 to 5 where 1 indicates that the issue did not impact the outcome(s) of the
collaboration and 5 indicates that the issue severely impacted the collaboration.

Members prioritized their personal
goals before the overall team goal
Difficulties in sharing data
The team members discuss issues
only at a broad level
Difficulties in sharing supplies, cells,
tissue or equipment
Responsibilities, roles, and
expectations were not clear
Difficulties in organizing travel
Team members became competitive
with one another
Difficulties in communication across the
scientific disciplines
Lack of funds
Power struggles
Sharing credit
The team did not meet regularly
The team did not establish trust
There is no reward structure at my
institution for collaborations
Trouble identifying additional team
members to help
Lack of clear vision or goals
No agreement on the primary
spokesperson

Yes, I
experienced
this

Don’t
Know

☐
☐
☐

DK
DK

☐

DK

☐
☐
☐

DK

☐

DK

☐
☐
☐
☐
☐
☐

DK

☐

DK

☐
☐

DK

1=no impact
5=severe impact
1

2 3

4

5

DK

DK
DK

DK
DK
DK
DK
DK

DK

7

Former Trainee Survey Sample Questions –Version #3

19.

Please answer the following questions with the approximate number of
investigators (i.e., faculty level researchers
0

How many PS-OC investigators
within your Center did you work
with prior to the start of the PSOC program?
How many PS-OC investigators
from your Center do you work
with now?
How many of these new
collaborations would have
started without PS-OC program
funding?
How many do you anticipate will
continue into the future?

20.

5/8/15

1-4

5-10

11-15

16+

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

From your perspective, please evaluate the extent to which the PS-OC program
has been successful in the following areas.
Excellent

Improving leadership skills in
heading a trans-disciplinary study
Mentoring junior faculty in
leading and participating in a
trans-disciplinary study
Increasing the discussion about
team science and collaborations
at your institution
Developing better policies to
review and reward the team
science at your institution

Fair

Poor

Don’t
Know

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

8

Former Trainee Survey Sample Questions –Version #3

20.

5/8/15

From your perspective, please evaluate the extent to which the PS-OC program
has been successful in reaching the following program goals.
Excellent

Form trans-disciplinary teams
focused on establishing physical
sciences-centric themes in cancer
research
Build a collaborative transdiscipline research sharing
network
Promote collaboration by PS-OC
researchers across the PS-OC
network
Educate trans-disciplinary
scientists that pursue careers in
the field of physical sciences in
oncology
Promote collaboration by PS-OC
researchers beyond the PS-OC
network
Form new physical sciences in
oncology programs at universities
or institutions
Test dogma-challenging
hypothesis or cancer initiation
and progression
Bring new types of scientists to
cancer research
Generate new datasets in cancer
research
Generate new knowledge in
cancer research

Fair

Poor

Don’t
Know

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

5

4

3

2

1

DK

21. Please provide any additional comments that you would like to share about the
convergence of physical sciences in oncology or the PS-OC program.

9

NCI Grantee Survey

5/8/15
OMB # 0925-XXXX
Expiration Date: XX/XXXX

NCI Grantee Survey
Public reporting burden for this collection of information is estimated to range from 10 to 25 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a currently valid OMB control
number. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC
7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx). Do not return the completed form to this address.

Thank you for taking the time to complete this survey for the National Cancer Institute
(NCI). We are conducting and evaluation of how specific types of professional program
involvement may impact a variety of professional outcomes. Your answers to this
survey will help provide valuable information and will help NCI make informed future
program decisions.
When completing this survey, please think specifically about your experiences with the
PS-OC, ICBP, EDRN, CCNE, TMEN, or MMHCC program, and program components you
have used over the last five years.
1. To begin, please indicate your level of involvement with each of the following within
your consortium or research network during the last five years.
Program Elements

Annual meetings
Reading newsletters/emails from the program
Participating in steering committee meetings
Receiving a site visit
Reporting requirements that I track and submit
Feedback from program officials on progress reports
Interactions and familiarity with program official(s)
Participating in working groups
Attending young investigator meetings
Participating in network/group activities and projects
Using/participating in special issue journals or specialized
workshops
Using additional resources (data coordinating centers,
biospecimen resources, data sharing plans)

High

Level of Involvement
Moderate

None

5
5
5
5
5
5
5
5
5
5
5

4
4
4
4
4
4
4
4
4
4
4

3
3
3
3
3
3
3
3
3
3
3

2
2
2
2
2
2
2
2
2
2
2

1
1
1
1
1
1
1
1
1
1
1

5

4

3

2

1

1

NCI Grantee Survey

5/8/15

If the investigator selects a “2” or higher on any of the above program elements, they
will be asked to answer two questions about that program element. This is
demonstrated below for the first program element, Annual Meetings:

Annual Meetings
2. How much has your participation in these annual meetings contributed to the
following?
Level of Contribution of
Annual Meetings to:

High

Making new professional contacts
Using new professional collaborations in my research
Working on translational research
Making research progress towards grant development
Receiving grant awards
Working on innovative cancer research
Working on impactful cancer research
Developing new infrastructure for cancer research at my
institution
Disseminating my research

Moderate

None

5
5
5
5
5
5
5
5

4
4
4
4
4
4
4
4

3
3
3
3
3
3
3
3

2
2
2
2
2
2
2
2

1
1
1
1
1
1
1
1

5

4

3

2

1

3. Was there one single outcome that your participation in annual meetings
contributed to the most? Select only one from the list below.

☐
☐
☐
☐
☐
☐
☐
☐
☐

Making new professional contacts
Using new professional collaborations in my research
Working on translational research
Making research progress towards grant development
Receiving grant awards
Working on innovative cancer research
Working on impactful cancer research
Developing new infrastructure for cancer research at my institution
Disseminating my research

3a. Can you describe in more detail below how this program element helped lead to
this outcome?

2

NCI Grantee Survey

5/8/15

Demographics
4.

☐
☐
☐
☐
☐
☐
☐
☐
☐
☐

5.

☐
☐
☐
☐
6.

☐
☐
☐
☐
☐
☐
☐
☐

Please identify your primary affiliation with the Physical Sciences-Oncology Centers
Program (select only one).
Center Principal Investigator (PI)
Center Senior Scientific Investigator (SI)
PS-OC Project/Core Investigator (i.e., project/core leader or research
investigator)
PS-OC Trainee
PS-OC Advocate
PS-OC Outreach and Dissemination Unit Lead
PS-OC Education and Training Unit Lead
PS-OC Administrator
PS-OC External Advisor
I am not associated with the PS-OC Program

Which of the following best describes your scientific background/training?
Physical Scientist
Cancer Biologist/Oncologist
Trans-disciplinary Researcher
Other: Please explain: _______________________________
What is your professional title?
Research Scientist
Assistant Professor
Associate Professor
Full Professor
Department Chair
Cancer Center Director
Dean
Other: Please explain: _______________________________

3

Review Panel Scoring Sheet - Version#3

5/8/15
OMB # 0925-XXXX
Expiration Date: XX/XXXX

Expert Review Panel Scoring Sheet – Version #3
NOTE: This form is being designed for online entry. The publication titles being
reviewed will be embedded directly into the document.
Public reporting burden for this collection of information is estimated to be 8 hours per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is
not required to respond to, a collection of information unless it displays a currently valid OMB control number.
Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974,
Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx). Do not return the completed form to this address.

INSTRUCTIONS
This packet contains (*Total Number*) papers/publications for your review. Please
review each of the papers in this packet while considering the following:
• The impact of each researcher’s individual paper(s) on the field of cancer
research.
• The impact of a researcher’s set of papers, taken as a whole, on the field of
cancer research.
• The innovation of the approaches taken in the researcher’s individual
paper(s).
• The innovation of the approaches taken in the researcher’s set of papers
taken as a whole.
Please read through this entire form before your begin your review. Links to the
papers you will be reviewing are included directly in this document.

If you are reviewing more than one set of papers, you will be sent a separate review
sheet for each set. Please complete each review sheet separately for each set of
papers you are being asked to review.
If you have any questions as you proceed, please contact (*name*) and (*email
address*).
The review sheet begins on the next page.

1

Review Panel Scoring Sheet - Version#3

5/8/15

1. How would you rate the impact of each of the following individual papers on
the field of cancer research? Please select the number that best represents
your response.
Very High
Impact

Moderate
Impact

No
Impact

Title of Paper 1

5

4

3

2

1

Title of Paper 2

5

4

3

2

1

Title of Paper 3

5

4

3

2

1

Title of Paper 4

5

4

3

2

1

Title of Paper 5

5

4

3

2

1

1a. How would you rate the impact of this set of papers, taken as a whole, on the
field of cancer research?
Very High
Impact

Set of Papers

5

Moderate
Impact

4

3

No
Impact

2

1

2. Did you observe any of the following types of impact in this set of papers?
(Check all that apply)

☐ Radically changes present understanding of an important existing scientific
concept

☐ Leads to the creation of a new paradigm or field of science
☐ Challenges present understanding in the field
☐ Provides pathways to new frontiers
☐ Challenges conventional wisdom
☐ Leads to unexpected insights that enable new techniques or methodologies
☐ Redefines the boundaries of the field of science
☐ Solves long-standing questions, providing opportunities for moving forward
☐ Has high translational or clinical potential
☐ Is likely to lead to technology transfer, patents or spin-offs
☐ Other: (please specify: )
2

Review Panel Scoring Sheet - Version#3

5/8/15

3. Regardless of the impact of the research, how would you rate the level of
innovation in the approaches taken in each of the individual papers in this
packet?
Extremely
Innovative

Moderately
Innovative

Not at All
Innovative

Title of Paper 1

5

4

3

2

1

Title of Paper 2

5

4

3

2

1

Title of Paper 3

5

4

3

2

1

Title of Paper 4
Title of Paper 5

5
5

4
4

3
3

2
2

1
1

4. Regardless of the impact of the research, how would you rate the level of
innovation in the approaches taken in this set of papers as a whole?
Extremely
Innovative

Set of Papers

5

Moderately
Innovative

4

3

Not at All
Innovative

2

1

5. Did you observe any of the following types of innovation in this set of papers?
(Check all that apply)

☐ New methodology employed
☐ Cutting edge approach to the topic
☐ New combination of approaches used
☐ Creative combination of disciplines and/or materials used
☐ The ideas underlying the research are at odds with prevailing wisdom
☐ The research requires the use of equipment or techniques that have not been
proven or are considered extraordinarily difficult

☐ Creative use or improvement of existing techniques
☐ Other: (please specify: )

3

Review Panel Scoring Sheet - Version#3

5/8/15

6. How closely aligned is your personal field of research with the field of
research that you reviewed in this packet?
Extremely
Aligned

Set of Papers

5

Moderately
Aligned

4

3

Not at All
Aligned

2

1

4

From:
To:
Subject:
Date:

Moore, Nicole (NIH/NCI) [E]
Eiserman, Julie (NIH/OD) [C]
Re: Follow Up re: Request for Determination OHSRP# 12934
Wednesday, June 03, 2015 2:54:24 PM

Hi Julie
Yes. The sole purpose of the activity is for a program evaluation. There is no research
component.
Best
Nicole

On Jun 3, 2015, at 2:38 PM, Eiserman, Julie (NIH/OD) [C] wrote:
Hello Dr. Moore,

I am following up with your regarding your request for a determination.  Can you tell
me if the sole purpose of your planned activity a program evaluation or a quality
assessment or improvement effort for internal use only?  Or would you say this activity
is also research, which as defined under the DHHS regulations is a systematic
investigator to develop or contribute to generalizable knowledge? 

If the activity is purely program evaluation or quality assessment or improvement and
not research, just keep in mind that you don’t need to submit that type of project to us
in the future.  We will however provide a determination for you today, since you did
submit a request to us.

Julie M. Eiserman, MA, CCRP [C]
Health Science Policy Analyst
Office of Human Subjects Research Protections
Office of Intramural Research, Office of the Director
National Institutes of Health
10 Center Drive, Bldg. 10, Suite 2C146
Bethesda, MD  20892-1154
Direct Phone: 301-402-8665
Fax: 301-402-3443
Email: julie.eiserman@nih.gov
OHSRP website: https://federation.nih.gov/ohsr/nih/index.php (NIH login required)
Public site: http://ohsr.od.nih.gov/

OHSR (NIH/DDIR)
From:
Sent:
To:
Subject:
Attachments:

Moore, Nicole (NIH/NCI) [E]
Monday, May 11, 2015 9:37 AM
OHSR (NIH/DDIR)
Request for for OHSRP Determination for Survey
IRB Exception 2015_Signed.pdf

Hi, 

Attached please find a completed signed OHSRP determination request form for surveys along with the survey 
questions.  These surveys are for evaluation of the Physical Sciences in Oncology Centers Program at NCI. 

Please let me know if you have any questions.  I look forward to hearing from you. 

Best, 
Nicole 

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 

Nicole M. Moore, D.Sc. 
Program Director 
Structural Biology and Molecular Applications Branch 
Division of Cancer Biology 
National Cancer Institute 
Tel. 240‐276‐7624 
Cell. 301‐325‐7534 
Email. nicole.moore@nih.gov 
PS‐OC Web. http://physics.cancer.gov      

1

OHSR (NIH/DDIR)
From:
Sent:
To:
Subject:

OHSR (NIH/DDIR)
Friday, May 15, 2015 2:26 PM
Moore, Nicole (NIH/NCI) [E]
Req for Determination Rec'd_OHSRP 12934

Good afternoon Dr. Moore, 

This email is to verify that OHSRP has received your Request for Determination and it is currently being processed as 
OHSRP #12934. Please use this number in any future correspondence regarding this study.    

Protocol Title: Early Outcomes Assessment of the Physical Sciences‐ Oncology Centers Program 

Thank you. 

Sincerely,  
Chris Brentin 
OHSRP ‐ National Institutes of Health 
Bldg 10, Suite 2C146                                                                                                                           
Bethesda, MD 20892 
Office Telephone: 301‐402‐3444 
Office Fax: 301‐402‐3443 

The NIH is committed to maintaining the highest standards for the protection of human
subjects.  

Please consider the environment before printing this e-mail 

1