Form 1 Access Request

The National Institutes of Health (NIH) NeuroBioBank Tissue Access Request and Progress Report Forms

Att 2_NBB Tissue Access Request_Other US Federal Govt Agency

NBB Tissue Access Request Form (Other US Federal Government-Funded Research)

OMB: 0925-0723

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Kaltlln Taylor -

NeuroBioBank

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Submit a Request for Tissue Samples
Plannlnt; th� R.nd ol�@r\'ma�les
Is the !'R

Name of funding Aghould be
followed more sirictly and v,hich Qn be followed more toosely. Haa1ing less
strict requirements "Alill nllo•,ifor a widernmee of avail �ble sped mens.

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Ml;ass Change forAmount Reque5ted

@All Specimens Olly Brain l!flllion

Edit R equested !:ipecimen(s)

El Request Details
llllfl of Re,euch Pl;,n •

Describf! this re,quest, including a summary ofth" rational", main hypoth..,;is and proposed ,,.,,.,.rch aims•

1-. bnel o�er�e.., of'{Otlr research needs.

Describe the assay krt{s)/platform(s:, to be used, if applicable.

Ha\fe you u,ed the proposed methods with human post-mortem tissue?•
Yes
No

Rationale for biospecimensrequested•

Pl�as• prnvifiace soeLi,.,E11S.

Is this a pilot study?*
Yes
No

Will the resulh be u�ed fur a commercial purpO!ie?•

I'. "Yes'" ref;"onsc deftn,,� this .is .i ·commac1.i1 PUrposc·· rc,qucsi,
y��
No

Commenb

/4
NeuroElioBank D�b :Sh�ring
RM-�archN� conducting ,:,tudie3 U3ing NcuroB!OBank spccrncns arc required to �har� their data lo lowin g the Findable, Acc-�s�ible, Interoperable, and Rcu�ablc (FAIR) guidelinM of tJIH
D�t� IJanaqement and Sharing poli:y. Researchers are stron�ly encouraged to subm� genomic and/or trans<:rip;omic d3:a generated from NeuroBioBank specimens to lhe tJeuroBioElank
Data Repcs�ory in MMH DataAfc h ve.
Plea"" attach a CV for the Principal Investigator.•
When ynu ,att,a�h lhf' fi'f', rlP"s" mr.kf' sLJrf' thf' Onrnmf'nt Typ? i� Sf'11n "Prin�ir,al lnVPsti9,atnr r.v"

We also encounoge uploading any add ti on al supporting documema1ion that is relevant to 1·our tissue reque,t Uploading supporting documentation for your rationale, power anal11sis,
e:c. may ,mprove request revre1,1 t,mes."

Attach Files
Filfl

Document Type

Principal lm,e,tig,ator OJ
Attic Power Analys,�
R.iliun�I� Suppurling Du�urmml�liun
Ch l111dg��
'lou m 0th� Oocumemrnion

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