Form 1 NINDS CDE Project form

NINDS CDE Project: CDE Project Request form

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OMB#:0925-0766 Exp Date: 04/2023

This form can be used to propose CDE development for neurological disease/condition research areas with no existing CDEs, for development of a new subgroup of CDEs for an existing CDE set, or for substantial revisiting/revising an existing CDE set.

Questions? Contact:

Carolina Mendoza-Puccini, MD

NINDS CDE Project Officer

[email protected]

Date: MM/DD/YYYY

Point of contact for this request

Name: ___________

Affiliation: _______________________

Title: _______________

Email: ________________

1. Please indicate if you are requesting that the NINDS CDE Project develop a new disease using our contract, or if you or your group need assistance from our CDE team to develop new CDEs.

2. Briefly describe the scope of research for which CDEs should be developed or substantially revised.

3. Are there any current or imminent NINDS-funded or co-funded studies that would benefit from development of new or substantially revised CDEs? If yes, please include the following information. (Maximum 10 studies)

NINDS-funded study #1 project number:________________________________

NINDS-funded study #2 project number:________________________________

NINDS-funded study #3 project number:________________________________

NINDS-funded study #4 project number:________________________________

NINDS-funded study #5 project number:________________________________

NINDS-funded study #6 project number:________________________________

NINDS-funded study #7 project number:________________________________

NINDS-funded study #8 project number:________________________________

NINDS-funded study #9 project number:________________________________

NINDS-funded study #10 project number:_______________________________

4. List evidence or scientific reasons that support the need to develop a new CDE or substantially revise CDEs in this research area.

5. Briefly describe any additional evidence that the scientific community is ready to create and use the requested CDEs.

6. Propose up to 3 names of non-government experts in this research area that might be appropriate to lead the scientific process of CDE development.

7. Propose any additional NIH Institutes or Centers or other government agencies that would be appropriate as active participants in the NINDS CDE development process.

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Jeon, Sophia (NIH/NINDS) [C]
File Modified	0000-00-00
File Created	2021-10-04