Developers of Medical Countermeasures to naturally occuring and intentional public health threats

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Request Meeting

Would you like to meet with a federal agency regarding a therapeutic product that you are developing? If you submit
some basic information on that product, we will evaluate your request and route it to the most appropriate resource
within the federal government. In some instances, it is not necessary or appropriate for a federal agency representative
to meet with companies regarding their products. In the event that a federal agency representative is unable to meet
with you, we will provide you with that information in a timely manner.
All submissions to MedicalCountermeasures.gov are voluntary and are for information only. However, the submission
of complete information may facilitate the routing of your request. It is important that we route your request to the most
appropriate federal entity. By selecting all federal entities listed below, you increase the probability that we will be able
to route your request appropriately. However, selecting all of the federal entities above does not guarantee that it is
appropriate for the federal government to meet with you at this time.
A field with an asterisk (*) before it is a required field
Requestor Phone

-

-

Company URL
Product Name
*Category of Threat Agent Chemical
Specific Threat Agent (choose Check All
all that apply)
c Biotoxins
d
e
f
g

http://hhsdev.dyonyx.com/Restricted/Therapeutics.aspx

Uncheck All
c Metals
d
e
f
g

g Blister Agents/Vesicants
c
d
e
f

g Nerve Agents
c
d
e
f

c Blood Agents
d
e
f
g

c Organic Solvents
d
e
f
g

g Caustics (Acids)
c
d
e
f

g Riot Control Agents/Tear Gas
c
d
e
f

c Choking/Lung/Pulmonary Agents
d
e
f
g

c Toxic Alcohols
d
e
f
g

g Incapacitating Agents
c
d
e
f

g Vomiting Agents
c
d
e
f

c Long-Acting Anticoagulants
d
e
f
g

c Other (Please Specify)
d
e
f
g

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MedicalCounterMeasures.gov

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Technology Readiness Level

Technology Readiness Level Descriptions

Proposed Indication for Use Check All
(Check all that apply)
c Pre-Exposure Prophylaxis
d
e
f
g
c Post-Exposure Prophylaxis
d
e
f
g

Uncheck All
c Mitigation Agent
d
e
f
g
c Other (Please Specify)
d
e
f
g

c Therapeutic
d
e
f
g

Uncheck All

Route of Administration Check All
c Intravenous
d
e
f
g

c Oral
d
e
f
g

g Intramuscular Injection
c
d
e
f

g Subcutaneous
c
d
e
f

c “Needle-Free” Injection
d
e
f
g

c Transdermal
d
e
f
g

g Intranasal
c
d
e
f

g Other (Please Specify)
c
d
e
f

Number of Doses Required for
Efficacy or per
Product Stability Years

Months

Temperature at which product is
stable (please indicate range)
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*Does your submission include n
j No n
k
l
m
j Yes
k
l
m
proprietary, confidential, or
trade secret information?
Please select those federal Check All
entities that you would be
b HHS/BARDA
c
d
e
f
g
interested in potentially meeting
with. Please do not select an g
b HHS/CDC
c
d
e
f
entity in which you are currently
competing for a contract under
as active solicitation issued in
accordance with the Federal
Acquisition Regulation.
Comments

http://hhsdev.dyonyx.com/Restricted/Therapeutics.aspx

Uncheck All
b HHS/FDA
c
d
e
f
g
b HHS/NIH
c
d
e
f
g

9/26/2007

MedicalCounterMeasures.gov

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9/26/2007