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

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

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Required format:

Ac2HYE9dVychQ4QGDAq343wpccRSnaS5QKp6aV75LcaoNiguSbXNkGjSAzruH

NCRAD Budget Request Survey

Thank you for your interest in the NCRAD Repository. Please complete the following questions in order for us to develop your budget. Please let us know if you have any questions along the way!

Last Name

First Name

Institution

Phone

Is there a contact for the project (different from the PI)?

Yes No

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Last Name

First Name

Phone

Is this request a response to an FOA or program officer direction?

Yes No

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What is the FOA/RFA number?

Is submission to NCRAD required by this FOA/RFA?

Yes No

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Who is the program officer?

What is the full name of the study?

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What is the study abbreviation?

Is this study already active?

Yes No

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What is the proposed start date (with NCRAD)?

M-D-Y

What is the study duration?

How many sites will enroll?

How many sites are outside the United States?

Where are the International sites located?

How many participants will be enrolled total?

What is the participant recruitment criteria for your study?

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What is the enrollment setting for your study?

Clinic

Community

Other

Clarify "Other" enrollment setting

Demographics (race, ethnicity, years of education, ADI/RUCA) of recruitment catchment area

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Anticipated race and ethnicity enrollment goals?

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Anticipated enrollment goals by years of education (proportion above and below 12 years of education)

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Anticipated enrollment goals of rural participants

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Is your study longitudinal?

Yes

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Please fill in the number of participants expected to have a visit in each year:
Visit	Year 1	Year 2	Year 3	Year 4	Year 5
Baseline
Total

Including baseline, how many visits will be conducted per participant?

What is the time frame for the visits?

Monthly

Every 6 Months

Annual

Other

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Are the same specimens collected at every visit?

Yes

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What is the visit schedule?

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Please fill in the names of the visits in the "Visit" column, and the number of participants expected to have a visit in each year in the "Years 1-5" columns:

Visit	Year 1	Year 2	Year 3	Year 4	Year 5






Total

What sample types will be collected?

DNA (whole blood)

DNA (buffy coat-often from same EDTA tube as plasma)

DNA (saliva)

DNA (transferred aliquots)

RNA (whole blood PAXgene blood tubes)

Plasma (processed from EDTA blood tubes)

Serum (processed from serum blood tubes)

Whole Blood to store

CSF

Urine

Saliva

Fecal

PBMC (whole blood NaHep tubes)

Other

How much blood for DNA is expected to be collected from each participant at each visit?

How many buffy coat samples are expected from each participant at each visit?

How many buffy coat aliquots will be transferred to NCRAD?

All collected

Other

How many saliva samples (for DNA) are expected from each participant at each visit?

How frequently will DNA aliquots be transferred?

What size aliquots will be transferred to NCRAD? NCRAD typically requests at least 5ug.

Can NCRAD store and share any residual DNA?

Yes

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How much blood for RNA is expected to be collected from each participant at each visit?

How much blood for plasma is expected to be collected from each participant at each visit?

What is the aliquot size?

1500 uL (1.5 mL)

1000 uL (1.0 mL)

500 uL (0.5 mL)

Other

How many plasma aliquots will be transferred to NCRAD?

All collected

Other

Please provide details on aliquots to be transferred

How much blood for serum is expected to be collected from each participant at each visit?

What is the aliquot size?

1500 uL (1.5 mL)

1000 uL (1.0 mL)

500 uL (0.5 mL)

Other

How many serum aliquots will be transferred to NCRAD?

All collected

Other

Please provide details on aliquots to be transferred

How much blood to send as unprocessed/frozen whole blood is expected to be collected from each participant at each visit?

How much CSF is expected to be collected from each participant at each visit?

What is the aliquot size?

1500 uL (1.5 mL)

1000 uL (1.0 mL)

500 uL (0.5 mL)

Other

How many CSF aliquots will be transferred to NCRAD?

All collected

Other

Please provide details on aliquots to be transferred

How much urine is expected to be collected from each participant at each visit?

What is the aliquot size?

1500 uL (1.5 mL)

1000 uL (1.0 mL)

500 uL (0.5 mL)

Other

How many urine aliquots will be transferred to NCRAD?

All collected

Other

Please provide details on aliquots to be transferred

How many saliva samples (not for DNA) are expected from each participant at each visit?

How many fecal samples are expected from each participant at each visit?

How much blood for PBMCs is expected to be collected from each participant at each visit?

What other sample types do you wish to collect?

Other site/visit details or notes

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Will you need collection kits from NCRAD?

Yes

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Should NCRAD plan for any distributions?

Yes

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What kind of distributions should NCRAD plan for?

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Will NCRAD need to budget for any shipping expenses?

Yes

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What kind of shipping expenses should NCRAD plan for?

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Will you need biomarker assays run in the NCRAD Biomarker Assay Laboratory (BAL)?

Yes

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Please complete the survey at this link.

What is the final deadline for receiving the budget?

M-D-Y

Other details/notes

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.

NCRAD Budget Request Survey

Please fill in the number of participants expected to have a visit in each year:

You have selected an option that triggers this survey to end right now.