Injury Control Research Centers (ICRC) Indicators Data Collection 20XX – Non-CDC Study Supplement
Form Approved
OMB No.: 0920-xxxx
Expiration Date: XX/XX/XXXX
Public Reporting burden of this collection of information is estimated at 5 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NW, MS D-74, Atlanta, GA 30333; Attn: PRA (0920-XXXX).
Awardee
FOA Number
Please refer to the companion ICRC indicator template guidance document for instructions on completing this template.
Studies supported with ICRC funding, ICRC supported personnel, or other funding. These studies are in addition to the CDC supported studies identified in the main ICRC Data Collection Document.
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
What additional information do you want to provide about completed and ongoing studies (e.g., cross-disciplinary nature of studies, innovative studies, how a study impacted the field, how studies related to your previous studies or planned future studies, etc.)? (There is no character limit for this response)
Describe any other proposed research-related objectives and activities for the budget year and any significant programmatic changes.
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File Modified | 0000-00-00 |
File Created | 0000-00-00 |