Data Access Request Instructions

Step 1: Read the Data Use Certification (DUC) document.
Requesters and Authorized Signing Officials are required to accept the terms and conditions in the DUC.

Step 2: Fill out and submit the Data Access Request (DAR)/SF 424 form

Data Access Request Policy Update:

As of October 1, 2007 the Project Summary and Statement of Intent in Appendix 1 are required for inclusion in all Data Access Requests. Please follow the step-by-step instructions carefully.

DAR/SF 424 Form Instructions

The DAR/SF 424 form utilizes the Application for Federal Assistance (Form SF 424 (R&R)) solely to collect information, not as an application for funds.

The table below will guide you step-by-step through completing the DAR/SF 424 form. Only the fields highlighted in yellow must be filled upon submission.

After completion of all required fields and checking the box in 18 which indicates full agreement with the terms and conditions described in the Data Use Certification, requesters must mail, fax or email a scanned form in Adobe Acrobat (PDF) email attachment.

For additional help, please refer to the DAR/SF 424 form Frequently Asked Questions (FAQ).

Field Number	Field Name(s)	Actions / Notes
1	Type of Submission	SKIP / LEAVE BLANK
2	Date Submitted / Applicant Identifier	SKIP / LEAVE BLANK Please note: The Date will be entered by the system. The Applicant Identifier field also will be system-provided. This identifier will be a unique number assigned to a submitted request.
3	Date Received by State / State Application Identifier	SKIP / LEAVE BLANK
4	Federal Identifier	SKIP / LEAVE BLANK
5	Applicant Information	The information is for the Applicant Organization, NOT a specific individual. Complete all required fields, highlighted in yellow.
6	Employer Identification	SKIP / LEAVE BLANK
7	Type of Applicant	SKIP / LEAVE BLANK
8	Type of Application	Check only one box, either New or Renewal
9	Name of Federal Agency	SKIP / LEAVE BLANK
10	Catalog of Federal Domestic Assistance	SKIP / LEAVE BLANK
11	Descriptive Title of Applicant's Project	Enter a brief descriptive title of the project with reference to the specific dataset to be accessed. (For Example: Genetic variation in innate immunity in the CGEMS PLCO prostate cancer dataset.)
12	Areas Affected by Project (Cities, Counties, States, Etc.)	SKIP / LEAVE BLANK
13	Proposed Project Start Date / Ending Date	SKIP / LEAVE BLANK
14	Congressional Districts of Applicant and Project	SKIP / LEAVE BLANK
15	Project Director / Principle Investigator Contact Information	Enter all required fields. Please note: The email address field will be used in system-generated correspondence with the Requester. This email address MUST be accurate!
16	Estimated Project Funding	SKIP / LEAVE BLANK
17	Is Application Subject to Review by State Executive Order 12372 Process?	SKIP / LEAVE BLANK
18	Complete Certification	Check the "I agree" box to provide the required certifications and assurances, acknowledging full agreement with the terms and conditions described in the Data Use Certification. All investigators requesting data access must agree to the terms and conditions described in the Data Use Certification.
19	Authorized Representative	Complete all required fields, highlighted in yellow. The Authorized Representative is the individual with the organizational authority to sign for a grant application, otherwise known as the Authorized Organizational Representative (AOR) or the Signing Official. Please note: The email address field will be used in system-generated correspondence to the Authorized Representative to complete the Data Access Request. This email address MUST* be accurate!* AORs/SOs must sign their names in the "Signature of Authorized Representative" field and enter the date in MM/DD/YYYY format.
20	Pre-Application	SKIP / LEAVE BLANK

Appendix 1: Project Summary and Statement of Intent

The Project Title is required and must include the name of the CGEMS data set (either Breast Cancer or Prostate Cancer). Inclusion of a project summary and abstract is required. It should be a brief description of the proposed research suitable for dissemination to the public and it should include a statement of objectives and methods to be employed. This summary must not include any proprietary / confidential information. Please limit the summary to less than 200 typewritten words.

Appendix 2: Credentials and Additional Investigators

The first box for Investigator 1 profiles the Project Director / Principal Investigator (PD / PI or SO). Each independent Collaborating Investigator in a different institution must initiate and process a separate Data Access Request. The second box profiles the Signing Official who must be registered in the eRA Commons and must be assigned the PI Role in that system. The respective eRA Commons ID for each Signing Official must be provided in the Credential field.

Additional investigators from the same organization can be listed in the second section (boxes 3 and 4), and are required to submit a separate Data Use Certificate (DUC).

The following table provides instructions for entering Investigator and Signing Official profiles and credentials.

Field Name	Instructions / Notes
Prefix	Enter the prefix (e.g., Mr., Mrs., Rev.) for the name of the collaborating PD / PI or SO.
First Name	Enter the first (given) name of the collaborating PD / PI or SO.
Middle Name	Enter the middle name of the collaborating PD / PI or SO.
Last Name	Enter the last (family) name of the collaborating PD / PI or SO.
Suffix	Enter the suffix (e.g., Jr., Sr., Ph. D.) for the name of the collaborating PD / PI or SO.
Credential	Registration in the eRA Commons system for the SO is required. The assigned Commons User ID (the unique name used to log into the system) must be entered here.
Position / Title	Enter the title of the collaborating PD / PI or SO.
Department	Enter the name of primary organizational department, service, laboratory or equivalent level within the organization of the collaborating PD / PI or SO.
Organization Name	Enter the name of the organization of the collaborating PD / PI or SO.
Phone Number	Enter the phone number for the collaborating PD / PI or SO.
Fax Number	Enter the fax number for the collaborating PD / PI or SO.
E-Mail	Enter the e-mail address for the collaborating PD / PI or SO.

By submission of this request form, the Requester certifies that each listed Collaborating Investigator has read and agreed to the terms and conditions in the DUC.

Submitting the DAR/SF 424

By submitting the DAR/SF 424 you are certifying that you agree to the terms and conditions of data use as described in the Data Use Certification (DUC).

Application to the CGEMS Data Access Committee can be made by fax, mail or as an electronic Adobe Acrobat (PDF) email attachment sent to the following address.

CGEMS Administration Office

NCI-Advanced Technology Center

8717 Grovemont Circle

Gaithersburg, MD 20877 (by courier)

Bethesda, MD 20892-4605 (by US Mail)

Fax 301-443-7091

NCI_CGEMS_DAC@mail.nih.gov

Acknowledgment of receipt of application will be made within 4 working days.

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Last Updated: October 4, 2007