DERT Extramural Grantee Data Collection Survey

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Form Approved
OMB No. 0925-0657
Exp. Date 07/31/2018
(to be updated upon OMB approval)

Attachment A
DERT Extramural Grantee Data Collection Survey


Demographics and Background Information

Grant Number: _______________________

How did you learn about this funding opportunity?
 NIEHS Website
 Grants.gov
 Social Media (Twitter, Linked In, etc.)
 Colleague/Word of Mouth
 Conference/Webinar
 University-based Resource (Tech Transfer Office)
 Federal Register

What is your age?
 <30
 30-39
 40-49
 50-59
 60+

What degrees do you hold?  (Please check all that apply)
 AB, BA, BS, BSc
 MA, MS, MHS, MPH, MPA, MED, MSIH
 PhD, Sc.D, DSc
 MD 
 Other clinical degree (e.g. DO, DDS, MBBS, RN)
 Other please specify_______________
 None

In what year did you receive your highest degree? _______________ (drop down menu)

What is your current position?__________________________________________________

How long have you held that position? _________ Years   ________ Months


In what type of research do you engage? (Please check all that apply)

Indicate whether you research in a specific area was basic or applied (Please check all that apply)

Basic	 Applied
    • 	Biochemistry
    • 	Biophysics
    • 	Botany
    • 	Cellular biology
    • 	Ecology
    • 	Environmental Sciences
    • 	Epidemiology/Human or Cohort studies (new association between biological, social, and/or behavioral states determined)
    • 	Epigenetics
    • 	Genetics (GWAS)
    • 	Immunology
    • 	Medicine
    • 	Microbiology
    • 	Molecular biology
    • 	Neuroscience
    • 	Physiology
    • 	Toxicology
    • 	Other please specify________

If your research was applied…What types of applied research? (Please check all that apply)
    • Clinical Research
    • Public Health Research
    • Health Services Research
    • Intervention Research
    • Program or Policy Research
    • Technology Innovation
    • Translational Research
    • Other please specify________

FUNDING

Please indicate which sources of selected science portfolio-related funding you have had during your career to date.  
Funding Source
Please check all sources of selected science portfolio -related funding
(Please select all that apply)

	Career	Last 10 years
Please indicate which funding source was the primary funder for this research.

      Career	Last 10 years
NIEHS
		
		
NHLBI
		
		
NIAID
		
		
NICHD
		
		
Other NIH
		
		
CDC
		
		
AHRQ
		
		
FDA
		
		
EPA
		
		
HUD
		
		
NSF
		
		
Other US government (not listed above)
		
		
Foundations
		
		
Industry
		
		
University discretionary/ start-up funds
		
		
Local, state or regional government
		
		
Other, specify___________
		
		

For your NIH-funded selected science portfolio research, please indicate which types of funding you have received. (Please check all that apply).
 Research (e.g., R01, R03, R21)
 Program/Center (e.g., M, P and U awards)
 Career Development Individual (e.g., K awards; R23, R29)
 Fellowships (e.g., F awards)
 Institutional Training (e.g., T32)
 Technology Development (e.g., SBIR, STTR; R41-44, N43-44, U43-44)
 Other funding type (specify): _______________________________________

Please describe if and how you have used NIEHS funds to leverage other resources, including monetary and non-monetary support.________________________________________________

OUTPUTS

Research Outputs

Please indicate which of the following research outputs you have produced as part of this project and provide a brief description:

Research Output
Check all that apply:
Provide a brief description.
Animal Models

Animal model developed

Biological Materials


Biological material or application identified or developed as a result of the research study

Clinical
Products

Medication, drug compounds, clinical devices (includes development and testing of these products)

Databases,
Software,
Algorithms


Database resulting from the research study



Software resulting from the research study



Algorithm resulting from the research study

License Agreements


License agreement executed for intellectual property generated by the research study.

Measurement Instruments, Assays & Methods


Measurement instrument developed by the research study

Research Data (public or restricted)

Research data generated by the research study

Economic Outcomes

Research study findings result in a cost-effective intervention for a disease, condition, or disorder




Research study findings result in enhancement of existing resources and expertise



Research study findings result in increased performance, quality, and consistency in the delivery of health care services

Health Care Outcomes

Research study findings result in clinically effective approach in the management and treatment of a disease, disorder or condition

Quality of Life

Research study findings leads to enhancement of well-being among community members

Knowledge Transfer Outputs

Please indicate which of the following knowledge transfer outputs you have produced as part of this project and provide a brief description:

Knowledge Transfer Output
Check all that apply:
Provide a brief description.
Alternative/
Informal Dissemination


Research study is referred to or cited in a blog, tweet, wiki or other alternative mode of dissemination.



Research study is cited in a presentation, speech or teaching materials.

Biological Materials


Subsequent use of a particular biological material or application of the material generated by the research study in a bench study (basic science) or clinical trial study.



Preclinical data generated in support of investigational new drug (IND) application or to the receipt of an IND.



Clinical data generated in support of marketing a biological material (Biologic License Application) generated by the research study.

Clinical Guidelines

The clinical guideline refers to the research study or recommends the study for background readings.

Curriculum Guidelines


The curriculum guideline refers to the research study or recommends the study for background readings.

License Agreements


License agreement granted for use of intellectual property generated by the research study.

Mass Media

Mass media publication refers to the research study.

Material Transfer Agreements (MTA)

MTA executed for transfer of tangible property generated by the research study.

Medical Devices


Clinical trial study testing of a medical device generated by the research study.



Clinical data generated in support of marketing a medical device (510(k); Investigational Device Exemption, IDE; or Premarket Approval, PMA) generated by the research study.

Meta-Analyses

Research study cited in a meta-analysis.


Knowledge Transfer Output
Check all that apply:
Provide a brief description.
Pharmaceutical Preparations


Subsequent use of a drug generated by the research study in a bench study (basic science/preclinical) or clinical trial study, including application and/or receipt of an Investigational New Drug Application (IND) from the FDA.



Clinical data generated in support of marketing a drug (Drug Application, NDA; Abbreviated New Drug Application, ANDA; or 505(b)(2)) generated by the research study.

Ancillary Research Studies

Ancillary research study generated as a result of the research study.

New Research Studies


New research study generated as a result of the research study.

Subject Headings/
Thesauri

New subject heading or thesauri term or phrase resulting or related to the research study is applied.


Career Development Outputs

Career Development Output
Check all that apply:
Provide a brief description.
University Leadership Positions

Serve as Center Director, Department Chair, or other university leadership position

Organizational/
Conference Leadership Position

Serve as conference chair, organizational leader (Society of Toxicology, International Society of Environmental Epidemiology, etc.)

Nominated for Membership in Prestigious Organization

Nominated for membership in prestigious organization such as Institute of Medicine, American Association for Advancement of Science, etc.

Employment Promotion

Received promotion to higher level of employment, such as next level of professor, or scientist

Obtained Tenure Status

Obtained tenure status for research or teaching position

Trained or Mentored Students

Served as a mentor or trained students in the field of selected science portfolio

Additional Training or Certification Received

Obtained additional training (K awards) or certifications within the field of environmental health science

Training/Certifications Outputs
Career Development Output
Check all that apply:
Provide additional information.
Teaching

Taught courses in the area of the selected science portfolio
Number of courses taught:
Number of students taught:
Description of courses taught:
New Investigators Recruited to NIEHS

Recruited new investigators to submit applications to NIEHS
Number of new investigators recruited (new investigator has not previously had a substantial NIH award such as an R01, P30, etc.):
Young Investigators Recruited to NIEHS

Recruited early stage investigators to submit applications to NIEHS
Number of early stage investigators recruited (early stage investigators are within 10 years of their terminal degree or medical residency):

Describe the approaches you used to include/advance young investigators.

Which of these approaches was most effective? 
Describe why.

Describe the barriers you face to training the next generation of NIEHS scientists.


Dissemination Outputs

Please indicate which of the following mechanisms you have used to disseminate related knowledge and products stemming from your research.  (Please check all that apply).  
    • Published in peer-reviewed journals
    • Presented at scientific conferences
    • Participated in grantee meetings
    • Developed and disseminated curricula
    • Developed and disseminated interventions 
    • Participated in the development of clinical guidelines 
    • Developed and disseminated research tools and methods
    • Participated in workshops or trainings disseminating your research
    • Provided scientific testimony and briefings to legislators
    • Developed and published websites
    • Presented research in community forums
    • Developed fact sheets and pamphlets
    • Provided information for press releases
    • Other, please specify:_______________________________________________
As part of your research, you may have had the opportunity to engage with different types of individuals and groups. Please indicate what the nature of your personal engagement has been with each of the following groups. (Please check all that apply)
Group
Share information
Conduct joint projects or activities
Serve on boards or advisory panels
Provide formal testimony
Serve as employee or consultant
No interaction
Other researchers






University administration / program directors






Local, regional or national health officials






Environmental regulators






Food and drug regulators






Legislators and staffers






Business and industry representatives






Housing and urban development agencies






Advocacy groups






Community groups






Other : _______________________________







Commercialization Outputs

We are interested in whether your selected science portfolio -related research, regardless of funding source, has led to the development of intellectual property.   

Have you applied for one or more patents?
	Yes		 No

[IF YES] Provide the patent application number(s):____________________

[IF YES] What is the nature of your patents(s)?
    • New drug 
	New use of drug 
	Medical product or device
    • Environmental controls and services
    • New process or procedure
    • New research method
    • New gene
    • Other please specify 	______________________________

Have you commercialized your innovation based on your patent(s)?
		 Yes		 No

	[IF YES] 	How many units have you sold?	_______
			What is your total sales?		$______
	

	Have you licensed your innovation(s)?
		 Yes		 No

	Did any Federal agencies support this work?
	 Yes		 No
	
	[IF YES] Which other Federal agencies supported this work?  
	(Please check all that apply)
		
NIEHS

NHLBI

NIAID

NICHD

Other NIH

CDC

AHRQ

FDA

EPA

HUD

NSF

Other US government (not listed above)



Have you spun-off or started a new company based on your research related to the selected science portfolio?  
	Yes		 No

Community Partnership Outputs

Describe any community outreach outputs produced by your project, such as Outreach visits, interventions, curriculums, etc.: ________________________________________
______________________________________________________________________

Describe the target audience (include specific numbers of people reached if possible):
______________________________________________________________________
______________________________________________________________________

Describe the goal of the community partnership: _______________________________
______________________________________________________________________

Describe the ways community partners participated in the project: ________________
______________________________________________________________________

Describe any leadership roles community partners had in the project: ______________
______________________________________________________________________

IMPACTS

We are interested in assessing whether you think your research will have effects on long term outcomes (now or in the near future) through a variety of pathways, including clinical practice changes, reduced exposure to environmental hazards, or changes in public behavior and advocacy. For each of the following items, please mark the ’current’ box if you believe your research has already affected change in this area and the ‘future potential’ box if you believe it has the potential to affect change in the next 10 years. 

Impact Area
Impact Timing
    a. My research has led to greater understanding of selected science portfolio disease mechanisms
Describe impact:
Current	Future potential
    b. My research has led to greater understanding of individual, social, and environmental factors associated with selected science portfolio
Describe impact:
Current	Future potential
    c. My research has led to improved environmental measurement techniques
Describe impact:
Current	Future potential
    d. My research has led to increased evidence regarding effective interventions
Describe impact:
Current	Future potential
    e. My research has led to improved environmental control techniques
Describe impact:
Current	Future potential
    f. My research has led to changes in education outcomes for clinical/public health students
Describe impact:
Current	Future potential
    g. My research has led to changes in education outcomes for K-12 or families
Describe impact:
Current	Future potential
    h. My research has led to changes in business practices regarding selected science portfolio
Describe impact:
Current	Future potential
Impact Area
Impact Timing
    i. My research has led to changes in environmental standards or regulations for change to reflect selected science portfolio
Describe impact:
Current	Future potential
    j. My research has led to changes in environmental policies for selected science portfolio
Describe impact:
Current	Future potential
    k. My research has led to changes in clinical practice relevant to selected science portfolio
Describe impact:
Current	Future potential
    l. My research has led to changes in public knowledge and practices related to selected science portfolio prevention and control
Describe impact:
Current	Future potential
    m. My research has led to increased public advocacy for selected science portfolio prevention and control
Describe impact:
Current	Future potential
    n. My research has led to changes in behavior related to the field of selected science portfolio
Current	Future potential

 
Scientific Goals and Objectives 

Describe the key scientific findings associated with your funded research.

Describe the impact or potential impact of these findings on public health.

Describe the impact or potential impact of these findings on the field of XXX.

How did any workshops or meetings related to the selected science portfolio affect your project goals?

Prior to the FOA in this area, were you already conducting research in the selected science portfolio?

Describe any research objectives you were not able to achieve with the current budget allocated to this grant.


RFA Goals (if applicable)
 
The goals of the RFAs for this portfolio include: (list goals here.)

To what extent did your project address each of these goals?

Did the FOA encourage you to take your research in a new direction?

What obstacles are there in expanding this selected science portfolio?

Do you think a new FOA in the selected science portfolio could solicit research that would help overcome the obstacles you encountered?  
 Yes		 No

If yes, share your thoughts on how a funding opportunity could help; including development of tools or standardized measurements that are lacking, etc.:




Research Agenda

What selected science portfolio -related research topics would you like to see included among the NIEHS extramural research priorities over the next 5-10 years to address emerging science areas or areas where there are gaps in current research ________________________________________________________________________

________________________________________________________________________


Research Collaborations

Do/Did you collaborate with other grantees who are doing similar work? Yes/No

If so, describe the collaboration:_____________________________________________
______________________________________________________________________

Is there a collaborator or partner that you would like to work with more? Yes/No

If so, who and why? ______________________________________________________

What has prevented you from pursuing that relationship?_______________________

Is there anything NIEHS can do to help facilitate that relationship?________________
______________________________________________________________________



PROGRAM SUPPORT

How satisfied are you with the support you received from program staff, such as grantee meetings, communications, etc.?


Everything was Great
(5)
Mostly OK
(4)
So-So
(3)
Could have been better (2)
Provided little or no help (1)
Not Applicable
Grantee meetings






Regular communication






Workgroups






Sharepoint sites or similar web-based sharing






Webinars






Data or sample sharing






Methods or technologies






Other activities provided based on program or portfolio selected







What was the most beneficial type of support you received from program staff? And why?

Are there other support activities that NIEHS program staff could have provided that would have facilitated your research project? Yes/No

If yes, please describe:___________________________________________________

Grant Administration
Was there a budget change during the grant period?
Did you have trouble finding staff resources for the research?
Was there a change in research aim(s)?  If so, please provide details.

If collaborative or consortium type funding:
Describe your participation in the current consortium. 

In addition to your individual grant accomplishments, what do you see as the main accomplishments of the consortium efforts? (both methods and findings)

 [if history of funding from NIEHS] How does your experience with this consortium model differ from other grants you have been involved with at NIEHS?

What do you see as the primary benefits with funding this research through a consortium?

What are the primary challenges associated with funding this research through a consortium?

To what extent have joint products emerged from the consortium (e.g., joint publications, presentations, new collaborations, shared datasets, new grants?) 
What were the benefits and challenges involved in working on these joint products? 

How satisfied are you with those efforts? 

Do you anticipate continuing to collaborate with any of these consortium members after this grant is over?  Please describe your plans.

LESSONS LEARNED (Note to OMB: this section will be customized for each portfolio or program evaluation to address unique characteristics of the portfolio or program, such as the funding mechanism used or partnering and collaboration requirements. Potential questions are provided below.)

Would you recommend that NIEHS use the consortium model in future funding announcements?

What (if anything) would you want to see done differently related to how the consortium was convened or managed? 

Many grant programs today are specifically looking at research translation and the broader societal impacts of the use of research findings including informing regulation. Based on your experiences with this grant, what do you think is the best way to conduct research to translate findings to affect broader social impacts and/or to inform the regulatory process?

Are there any other lessons learned you would like to share regarding your participation in this grant?