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.

All fields are required.

Request Identifier
Full title for the proposed research
Requestor Information

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)

Principal Investigator Information
The Principal Investigator (PI) must have the level of authority and oversight responsibility to fulfill the OHRTA/OHDTA requirements for that role. Students and temporary staff are not eligible to sign the OHRTA/OHDTA as the PI. Please designate a faculty advisor or supervisor as the study PI, and include the names and titles of the student or temporary staff among the Other Authorized Users.
Authorized Users
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 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.
Specimen Shipping Information
*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?
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.
Institution Type
Number of years in scientific research
Approximately how many years has the lead investigator been involved in scientific research?
If funding is not yet available, please indicate anticipated primary funding source.
If funding is non-NIH, please attach supporting documentation below.
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.
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 gender, age, disease status, genotype, etc. Be as specific as possible.
Only applicable for studies that have more than one specimen draw point. If any visit is acceptable, please indicate so. Refer to the "Available Biospecimens" tables on each study description page for more information regarding the available visits for each material type. 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.
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 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.
Will the results be used for a commercial purpose?
A "Yes" response defines this as a "Commercial Purpose" request.
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 or specimens, 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