DUA Request

This is a request form for a Data Use Agreement. You do not need to proceed with this form if:


You are only transferring biospecimens, not data;

OR

You are not transferring human subjects data, but the data you are transferring is proprietary.


In either of these cases, do not continue with this Smartsheet form, but email mta@ohsu.edu so a Technology Transfer Agreements Manager can be assigned.

The questions below are required regardless of whether this is a new request, or if there is a draft from another institution already.

Multiple Institutions Involved?*

For this agreement, are you sharing:

If sharing data, are you:

Select
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Please provide information regarding the data that will be shared. This is not the scope of work, but a description of the data itself. Examples include:

  • Whether the data is obtained from human subjects and, if so, a description of the population included in the data;
  • if the data is from animal subjects, the species of animal the data was obtained using;
  • if not from human or animal subjects, a description of the focus of the data;
  • the number of subjects and/or experiments included; name of the study that the data was obtained under;
  • if there is a particular study that needs to be acknowledged/cited as the source of the data
IRB*

Does the project involve the use of data about a human subject?

Please explain why you are requesting a DUA if human subjects data is not being shared.

Select
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Select all data elements that will be shared

Will you only be sharing ages under 90 years old?*

Please describe the Project in sufficient detail below so that each party understands the Project to be undertaken using the Data. This is similar to a Scope of Work, examples include: objective/purpose of the work; description of the actions to be performed by Recipient with the Data; anticipated results; whether or not Recipient is able to link with other data sets, and any special requirements.

What methods will be used to share the data?

Please describe.

Outside OHSU Access*

Does anyone outside of your research group or institution need access to this data for the project?

Names of faculty, employees, fellows, or students of an academic institution, which institution (i) has agreed to collaborate in the Project, (ii) has faculty, employees, fellows, or students who have a need to use or provide a service in respect of the Data in connection with its collaboration in the Project.

Funding*

Are there any funding sources for this project?

Please list all funding sources, including award/agreement numbers.

How are costs to be reimbursed?

Select
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Other Agreements*

Are any other agreements in place, or being worked on, related to this project? (MTAs, BAAs, subawards, etc.)

List all other agreements, and the status (in process, executed, expired)

International Partners*

Does this project involve a foreign collaborator, and/or, is data being shared with or received from a foreign entity?

Please list the countries

Upon termination or expiration of the agreement, what should the recipient do with the data? (Destroy, return to OHSU)

Any other information you need the reviewer to know?

If you have a draft agreement, or any other relevant documents, please attach them here.

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