Form 1 GDC Data Submission request form

Privacy Act Notification Statement (PANS)
OMB No.: 0925-0752
Expiration Date: 05/31/2020
Collection of this information is authorized by The Public Health Service Act, Section 411 (42 USC
285a). Rights of study participants are protected by The Privacy Act of 1974. Submitting GDC Data
Submission Requests requires the submission of Personally Identifiable Information (PII). Please
see the GDC Privacy Policy and GDC Privacy Act Notification for additional information. Participation
is voluntary, and there are no penalties for not participating or withdrawing from the study at any
time. Refusal to participate will not affect your benefits in any way. The information collected in this
study will be kept private, under the Privacy Act. Names and other identifiers will not appear in any
report of the study. Information provided will be combined for all study participants and reported as
summaries. You are being contacted on-line to complete this instrument so that we can review and
assess the GDC data submission request.
Public reporting burden for this collection of information is estimated to be 15 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 (0925-0752)
Do not return the completed form to this address.
I agree. Continue to the formCancel

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Data Submission Request Form
Please fill out the following GDC Data Submission Request Form to describe your study in detail. For additional information, please see the Data
Submission Request Process [/submit-data/data-submission-processes-and-tools] and associated Data Submission Conditions [/data-submission-conditions].
Disclaimer:
Please do not provide any Protected Health Information (PHI) that contains identifiable IDs in this form.
The GDC Team will respond within 2 weeks.

Study Contacts

*required fields

Principal Investigator Name *

Principal Investigator Position *

Principal Investigator Institution *

Principal Investigator Address *

Principal Investigator E-mail *

Do you have an eRA Commons Account [https://commons.era.nih.gov/]? *
Yes
No
Is there a bioinformatician who will
support your data submission? *

https://gdc.cancer.gov/data-submission-request-form

Yes

No

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Study Description
Study Title *

Study Description (questions the study
will address and expected findings) *

What are the types of cancer being studied? *

Adrenal Gland, Adrenocortical Carcinoma
Adrenal Gland, Pheochromocytoma
Bile Duct, Cholangiocarcinoma
Bladder, Urothelial (transitional cell) Carcinoma

Hold down the control (ctrl) or
command button to select
multiple options.

NIH Grant Number (if applicable)

Supporting NIH Institute or Center (if
applicable)

- None -

Is the study required to submit data
based on the NIH Genomic Data
Sharing Policy

Yes

No

Yes

No

[https://osp.od.nih.gov/scientificsharing/policies/]? *

Is the study registered at dbGaP? *

What is the dbGaP phs number? (if
registered in dbGaP)

phs

How many cases will be submitted? *

Study Data

https://gdc.cancer.gov/data-submission-request-form

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Do you have the demographic (age, gender,
diagnosis) and diagnosis data? *

Data Submission Request Form | NCI Genomic Data Commons

Yes

No

The GDC requires a core set of clinical data
elements for capturing demographic and
diagnosis information as defined in the GDC
Data Dictionary
[https://docs.gdc.cancer.gov/Data_Dictionary/viewe
r/].

Do you have treatment data? *

Yes

No

Treatment data refers to information on the
action or administration of therapeutic
agents to produce an effect that is intended
to alter the course of a pathological process.

Do you have relapse/recurrence data? *

Yes

No

Relapse/recurrence data refers to

Yes

No

Do you have outcome data? *

What experimental strategies were
used in molecular characterization? *

Do you have biospecimen data? *

information associated with the return of a
disease after a period of remission.

Outcome data refers to information on a
specific result or effect that can be
measured. Examples of outcomes include
decreased pain, reduced tumor size, and
improvement of disease.

Molecular characterization experimental
strategies refer to the assay performed (e.g.

- Select -

DNA-Seq, RNA-Seq) to characterize the
molecular properties of the data. Select what
experimental strategies were used in
molecular characterizations from the pulldown list of experimental strategies
supported by the GDC.

Yes

No

Biospecimen data refers to information
associated with the biological sample,
portion, analyte, or aliquot. A set of
biospecimen data elements commonly used
across studies and required by the NCI GDC
are defined in the GDC Data Dictionary
[https://docs.gdc.cancer.gov/Data_Dictionary/viewe
r/#?view=table-entity-list&anchor=biospecimen].

Do you have experiment metadata? *

Yes

No

Experimental metadata includes sequencing
platform, library selection method, exome
capture kit description, and other experiment
details. Examples of fields and values for
this kind of data can be found in the
Sequence Read Archive Experiment
Schema
[http://www.ncbi.nlm.nih.gov/viewvc/v1/trunk/sra/do
c/SRA_1-5/SRA.experiment.xsd?view=markup].

Do you have information on the data
analysis protocol? *

Yes

No

Information on the data analysis protocol
includes information on the workflows used
to analyze the data. This may include
analysis information found in the Sequence

Read Archive Analysis Schema
[http://www.ncbi.nlm.nih.gov/viewvc/v1/trunk/sra/do

How many files will be submitted? *

https://gdc.cancer.gov/data-submission-request-form

c/SRA_1-5/SRA.analysis.xsd?view=log].

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What is the estimated size for the total
files (GB)? *

Additional Comments
Additional Comments

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