HOP Request Intake

HOP Request Intake

Please complete this form with details of your request. Following submission, you will be contacted by a member of the HOP team to confirm the details of your request.

For general inquiries, contact Wesley Stoller:

stoller@ohsu.edu

Request Contact

*if other than Project Lead

Request Contact Email

*if other than Project Lead

Key Collaborator

*if applicable

Key Collaborator's Email

*if applicable

If yes, will you be accessing HOP data for the proposed work?

Please see budget guidelines, template resources and environment.

Yes

What type of request are you submitting?

Data/sample inquiry

Data/sample use request

Survey addition

Recruitment assistance

Survey Considerations:

Survey additions also require a data use request in order to access the data collection from the new survey. Please select both options, or indicate below that this request is to study the feasibility of adding a survey and a data request will be submitted once a decision has been made to implement the survey.

HOP is an phone-based app. It is not suitable for long surveys (>20 items), games, or surveys with highly complex skip patters.

Will you be submitted a data request at this time?

Yes

No, data request will be submitted once feasibility has been completed.

Project Description*

Please provide a brief description of your request.

Please list the variables or samples you would like frequency counts for

If you need to review our data dictionary, please contact Wesley Stoller (stoller@ohsu.edu)

Study Description*

Please provide a brief summary of your project.

IRB Approval*

Do you have existing IRB approval for this project (protocol or NHS determination)?

Yes

IRB Number*

Please list your IRB protocol number and upload a copy of your submission documents to the file uploader at the bottom of this form.

IRB Timeline

Please indicate a timeline for IRB approval or rationale for why IRB approval is not needed.

NOTE: If you need assistance with this aspect of your project, please indicate so in the below text box.

Do you have a DUA or MTA in place?

If yes, please attach your signed DUA or MTA at the end of this submission form.

Yes

DUA or MTA timeline

If you do not have a DUA or MTA in place, please indicate your timeline for DUA or MTA approval.

NOTE: if you need assistance with this, please indicate so in the below text box.

Please list the variables/samples you are interested in using.

If you have a table shell or other document outlining your desired variables/samples, please use the upload feature at the end of this submission form.

NOTE: if you need to review our data dictionary or sample inventory, please contact Wesley Stoller (stoller@ohsu.edu)

Do you plan on submitting an abstract based on these results?

Yes

If yes, please indicate the due date for your abstract.

Name of the survey you would like to add:

NOTE: Please upload a copy of this survey at the end of this submission form.

Is this survey in the public domain (free to use in any form)?

Yes

Have you obtained a license to use this survey?

NOTE: if yes, please upload a copy of your licensing agreement at the end of this submission form.

Yes

Participant Criteria

Please list any eligibility criteria, such as demographic information, mutation status, etc. If you have no specific criteria, enter N/A.

Recruitment Targets*

How many participants do you need to recruit?

Data Description*

What data do you need from HOP? Please be as specific as you can.

Data Type*

What level of detail do you need in your data report?

Summary Data (e.g. percentages, participant counts)

Participant Level Data

Participant Numbers*

If applicable, please specify how many participants' data or DNA is needed. If you have no requirements, enter N/A.

Number of Data Pulls*

Data Pull Frequency*

Select

Anticipated Date of First Data Pull*

Anticipated Date of Final Data Pull*

Will you compensate subjects for survey completion?*

Yes

Compensation Amount*

Budget*

How much have you budgeted for participant payment?

Sample Volume*

Please indicate sample volume needed per participant, in μg.

Associated Data*

Please describe any data needed for your requested samples (e.g. demographic information, mutation status, HOP survey data).

IRB Considerations

HOP requires evidence of IRB oversight for any requests involving identifiable data or genetic research.

If you are a collaborator on the HOP IRB protocol, your project may require additional IRB approval.

Once your request is approved by the HOP team, we will provide guidance on any IRB requirements and how to obtain IRB approval.

Are you a collaborator on the HOP IRB protocol?*

Yes

Are you requesting identifiable data on HOP participants?*

Yes

Are you conducting genetic research?*

This includes research involving DNA specimens, genetic testing, or genetic information.

The IRB's definition of genetic research is broad, and includes any research involving DNA, RNA, and proteomics IF the protein being investigated is thought to be controlled by a genetic trait.

Yes

Is this a CEDAR funded project?*

Yes

Fee Waiver*

HOP charges $50/hour for repository services, including:

data report preparation
recruitment for other studies
survey addition to HOP app
DNA sample pulls

If you have a reason you feel the fee should be waived, please include it below.

Yes

Fee Waiver Justification*

File Upload*

Please upload your study abstract and any IRB approval documents, if applicable.

If you are requesting to add a new survey to the HOP app, please upload it here.

If you are using HOP to recruit for another study, please upload any IRB approved recruitment messaging you would like us to use.

Drag and drop files here or

Send me a copy of my responses

Contact Information

Request Details

Survey Considerations:

Heading

IRB Considerations

Costs & Funding