Data Access Request Form Instructions

National Human Genome Research Institute

National Institutes of Health
U.S. Department of Health and Human Services


Data Access Request Instructions

! Step 1: Read Data Use Certification (DUC).
Requesters and Authorized Signing Officials are required to acknowledge the terms and conditions in the DUC.

! Step 2: Fill out and submit Data Access Request (DAR) Form
Initiating a request requires NIH or eRA Commons Login. A User ID and password will be necessary to proceed.



DAR Form Instructions

The Data Access Request Form (DAR) utilizes the Application for Federal Assistance (Form SF 424 (R&R)) solely to collect information. This is not an application for funds.

The table below is to guide you step-by-step through filling the Data Access Request form. Only the fields highlighted in yellow must be filled upon submission.

The DAR requires NIH log-in. Requesters and institutional SOs must have an NIH eRA User ID and password to access the DAR. Visit era.nih.gov for more information on registering for a NIH eRA account. NIH staff may utilize their NIH log-in.

Page 1

Field
Number
Field
Name(s)
Actions / Notes

1

Type of Submission

SKIP / LEAVE BLANK

2

Date Submitted /
Applicant Identifier

SKIP / LEAVE BLANK

Please note: The Date will be entered by the system. The Applicant Identifier field also will be system-provided. This identifier will be a unique number assigned to a submitted request.


3

Date Received by State /
State Application Identifier

SKIP / LEAVE BLANK


4

Federal Identifier

SKIP / LEAVE BLANK


5

Applicant Information

The information is for the Applicant Organization, NOT a specific individual. The system will pre-fill many of the fields in this box. Fill in all remaining required fields except:

  • Organizational DUNS
  • County
  • The person to be contacted... sub-section


6

Employer Identification

SKIP / LEAVE BLANK


7

Type of Applicant SKIP / LEAVE BLANK

8

Type of Application

Select the type of application from the following list. Check only one:

  • New: A Data Access Request that is being submitted to NHGRI for the first time.

  • Renewal: A Data Access Request for an additional one-year period. A renewal application contains the same requirements (e.g., acknowledgement of the Data Use Certification) as the original plus required reporting on past use of the data as described in Appendices 5 and 6.

9

Name of Federal Agency SKIP / LEAVE BLANK

10

Catalog of Federal Domestic Assistance (CFDA) Number & Title (CFDA) SKIP / LEAVE BLANK

11

Descriptive Title of Applicant's Project Enter a brief descriptive title of the project with reference to the specific dataset(s) to be accessed.

(For Example: Protein tyrosine phosphatase gene variation in the TSP lung cancer dataset.)

12

Areas Affected by Project
(Cities, Counties, States, Etc.)
SKIP / LEAVE BLANK

13

Start Date / Ending Date SKIP / LEAVE BLANK

14

Congressional District Applicant / Congressional District Project SKIP / LEAVE BLANK

15

Project Director / Principle Investigator (PD / PI) Contact Information

Enter all required fields.

Please note: The email address field will be utilized in system-generated correspondence with the Requester. This email address MUST be accurate!

Page 2
Field
Number
Field
Name(s)
Actions / Notes

16

Estimated Project Funding SKIP / LEAVE BLANK

17

Is Application Subject to Review by State Executive Order 12372 Process? SKIP / LEAVE BLANK

18

Complete Certification

Check the "I agree" box to provide the required certifications and assurances.

All investigators requesting data access must agree to the terms and conditions described in the Data Use Certification.


19

Authorized Representative

The Authorized Representative is equivalent to the individual with the organizational authority to sign for a grant application, otherwise known as the Authorized Organizational Representative (AOR) or the Signing Official.

Please note:

The email address field will be utilized in system-generated correspondence to the Authorized Representative to complete the Data Access Request. This email address MUST be accurate!

AORs/SOs must enter their names into the "Signature of Authorized Representative" field and enter the date in MM/DD/YYYY format.


20

Pre-Application SKIP / LEAVE BLANK


Project Summary / Abstract

The Project Summary must contain a brief description of the proposed activity suitable for dissemination to the public. It should be a self-contained description of the intent for data use and should contain a statement of objectives and methods to be employed. Requests lacking sufficient description will be declined. This Summary must not include any proprietary/confidential information. Please limit your summary to the space provided.

Research & Related Senior / Key Person Profile

The first box profiling the Project Director / Principal Investigator (PD / PI) will be populated automatically with the information that was provided in the SF-424. If information needs to be added or modified, it must be done on the SF-424. Each independent Collaborating Investigator in a different institution must initiate and process a separate Data Access Request.

Each Senior / Key Person must be registered in the eRA Commons and must be assigned the PI Role in that system. The respective eRA Commons ID for each Senior / Key Person must be provided in the Credential field.

The table below provides instructions for entering Senior / Key Person profiles.

Field Name
Instructions / Notes

Prefix

Enter the prefix (e.g., Mr., Mrs., Rev.) for the name of the collaborating PD / PI.
First Name Enter the first (given) name of the collaborating PD / PI.
Middle Name Enter the middle name of the collaborating PD / PI.
Last Name Enter the last (family) name of the collaborating PD / PI.
Suffix Enter the suffix (e.g., Jr., Sr., Ph. D.) for the name of the collaborating PD / PI.
Position / Title Enter the title of the collaborating PD / PI.
Department Enter the name of primary organizational department, service, laboratory or equivalent level within the organization of the collaborating PD / PI.
Organization Name Enter the name of the organization of the collaborating PD / PI.
Division Enter the name of primary organizational division, office or major subdivision of the collaborating PD / PI.
Street 1 Enter the address for the collaborating PD / PI (e.g., Street Number, Street Name).
Street 2 Enter the address for the collaborating PD / PI (e.g., Suite Number, Room Number)
City Enter the city for the collaborating PD / PI.
County SKIP / LEAVE BLANK
State Enter the state for the collaborating PD / PI.
Province SKIP / LEAVE BLANK
Country Enter the country for the collaborating PD / PI.
ZIP Code Enter the ZIP code for the collaborating PD / PI.
Phone Number Enter the phone number for the collaborating PD / PI.
Fax Number Enter the fax number for the collaborating PD / PI.
E-Mail Enter the e-mail address for the collaborating PD / PI.
Credential, e.g., agency login

If you are submitting to an agency (e.g., NIH and other PHS agencies) where you have an established personal profile, enter the agency ID.

For NIH and other PHS agencies, registration in the eRA Commons for all PDs / PIs is required. The assigned Commons User ID (the unique name used to log into the system) for anyone assigned the PD / PI role must be entered here.

Project Role SKIP / LEAVE BLANK
Other Project Role Category SKIP / LEAVE BLANK
Attach Biographical Sketch SKIP / LEAVE BLANK
Attach Current & Pending Support SKIP / LEAVE BLANK


By submission of this request form, the Requester certifies that each listed Collaborating Investigator has read and agreed to the terms and conditions in the DUC.

Submitting the DAR

When all required fields on the DAR are complete, click Submit. By clicking Submit, you are certifying that you agree to the terms and conditions of data use as described in the Data Use Certification (DUC).

If required fields are left blank upon clicking Submit, the DAR will re-open with all required fields highlighted in red. Fill in the highlighted fields and click Submit.


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Last Reviewed: March 27, 2012