1. Home

The form templates are available here so that the requestor may become familiar with the information which will be requested on web request forms. The templates are not editable and cannot be used to submit a request. You may submit a request from our list of Currently Available Collections.

Request for Materials (biospecimens, data, and/or images) (Readonly)

If you are interested in requesting specific collection materials (biospecimens, data, and/or images) from the AgingResearchBiobank, initiate or update and submit the form below and a member of the our staff will contact you within 7-10 days. If desired, you may save the form instead and return to complete it at a later time. Note that the request form will timeout after one hour of inactivity. To ensure no input is lost, please save it within one hour of beginning the form.

Who Can Submit a Request

Requests to access materials must be submitted by a Requester, generally the Principal Investigator (P.I.) who:

Complete the Form Below

You will need to complete the required fields below and provide the following documentation before your request is reviewed by our scientific review committees:

If you are requesting biospecimens:

Requests will only be reviewed if all of the required documentation noted above has been submitted. The documents submitted will be examined to ensure they comply with the AgingResearchBiobank’s requirements prior to review by our review committees. If documents are missing, your submitted request will not be reviewed until the documentation is complete.

If your request is approved, an agreement ((Outgoing Human Resources Transfer Agreement (OHRTA) or Outgoing Human Data Transfer Agreement (OHDTA)) will need to be signed by the P.I. and the institution's signing official.

All fields are required.

What materials are you requesting? (select all that apply)
Check study pages to confirm that materials selected are available for your desired study(ies).

Request Identifier

Full title for the proposed research to be used in formal correspondence
Brief summary (1-2 sentences) of the proposed research to be made public if the request is approved. A more detailed summary and protocol are also required separately in the Request Details section below. (Limit 500 characters)

Requestor Information

e.g., Professor
e.g., PhD, MD, etc.
Number of Years in Scientific Research
Approximately how many years has the lead investigator been involved in scientific research?

Requesting Institution Type

Principal Investigator Information

The Principal Investigator (P.I.) must have the level of authority and oversight responsibility to fulfill the OHRTA/OHDTA requirements for that role. Lab Technicians, trainees (e.g., post-docs or graduate students) are not eligible to sign the OHRTA/OHDTA. The Requester that may serve as faculty advisor, supervisor or mentor must be the one signing as the study PI, and include the names and titles of the staff among the Other Authorized Users.

Please use the full legal name of the institution. Do not abbreviate.
e.g., Professor
e.g., PhD, MD, etc.
Approximately how many years has the lead investigator been involved in scientific research?
(include street address, city, state, zip code. Complete information is required.)

Authorized User Information

An Authorized User refers to any co-investigator or staff of the Primary Investigator (PI) that will have direct access to the research materials provided by the biobank. Examples could include those responsible for analyzing data files downloaded from this website. Those without direct access to these materials but in other roles on the project, e.g., literature review, or manuscript editing, need not be included.

Any Authorized User who is employed by a different institution will need to submit a separate requestfor access to the materials (biospecimens, data or images), provide a Signing Official from theirown institution, and sign a separate agreement. In that case, please refer to the originatingrequest in that separate request.

Please use the full legal name of the institution. Do not abbreviate.
e.g., Professor
e.g., PhD, MD, etc.
(include street address, city, state, zip code. Complete information is required.)

Signing Official Information

A Signing Official (SO) from your institution will be asked to provide their signature in the transfer agreement. An SO has institutional authority to legally bind the institution in grants or contracts administration matters. The individual fulfilling this role may have any number of titles in the grantee organization. For most institutions, the SO is located in its Office of Sponsored Research or equivalent.

Please use the full legal name of the institution. Do not abbreviate.
e.g., Professor
e.g., PhD, MD, etc.
(include street address, city, state, zip code. Complete information is required.)

Biospecimen Shipping Information

e.g., Professor
e.g., PhD, MD, etc.
*Note: Specimens will be shipped to the above address. Specimens cannot be shipped to a post office box.

Support Information

Is funding currently available for this research?
If funding is not yet available, please indicate anticipated primary funding source.
If funding is non-NIH, please attach supporting documentation below.
Do you require a letter of biospecimen availability for inclusion in a grant application?
Please specify if you require a letter by a certain date. Note that a letter is generally prepared within six weeks of receiving criteria applicable to the requested study.

Request Details

Please select the studies you would like to request. If requesting SWAN, that is the only study you may request.
Have you previously acquired data, images, or biospecimens from the study collection(s) being requested?
Does your proposal require linking biobank materials to the existing data, images, or biospecimens described above?
A brief overview of your research needs. This is in addition to the full protocol to be attached below.
Include the participants inclusion/exclusion criteria, study visit periods, key analytic variables, primary and secondary outcome measures, follow-up period if applicable, and planned statistical methods. Inadequately described request may be deferred until a complete/ satisfactory description is provided.
Will the results be used for a commercial purpose?
A "Yes" response defines this as a "Commercial Purpose" request.
Describe any additional requirements pertaining to the biospecimens themselves, such as anticoagulant used, additives, preservatives, etc.
Describe the characteristics of the subjects to be searched for available specimens. Criteria might include sex, age, disease status, genotype, etc. Be as specific as possible.

If requesting biospecimens: Only applicable for studies that have more than one specimen draw point. If any visit is acceptable, please indicate so. If more than one visit is requested, please indicate if you can accept subjects that have specimens available from at least one, but not all of the requested visits.

If requesting images: Only applicable for studies that have more than one imaging visit. If any visit is acceptable, please indicate so. If more than one visit is requested, please indicate if you can accept subjects that have images available from at least one, but not all of the requested visits.
Approximate count of subjects required for your study. This may be the same as the number of specimens if only one draw and material type is needed per subject.
Approximate count of specimens required for your study. This may be more than the number of subjects if more than one draw and/or material type is needed per subject.
Please provide the minimum volume necessary to perform the work described on this request form so as not to unnecessarily deplete limited resources. Unused samples cannot be returned to the biobank and may not be used by the requestor for other purposes without explicit authorization in an amendment to the Materials Transfer Agreement (MTA), signed by NIA and the requesting institution. Please include units.
Please include units.
Describe the assay(s) to be performed and include any test volume requirements.
Describe the assay kit(s)/platform(s) to be used, if applicable.
Also describe your intended use of covariates from study datasets, if applicable.
Original Study Investigator?
Were you an investigator with the original (parent) study(ies) referenced in this request?
Information Security: Please check the information security practices to be used.
Study data must be maintained in a secure and controlled environment.
Will anyone else besides the PI and authorized users noted above have access to these data, biospecimens, or images (including lab personnel)?
e.g., Amazon Web Services, Microsoft Azure, Google Cloud Platform / what tools will be used and how these tools relate to the project