1301 Att 4_Non-research determination

REQUEST FOR DETERMINATION OF RESEARCH STATUS
To be completed by the staffmember with lead responsibility for the project and approved by branch chief (if applicable) and Division
ADS. A separate PGO funding memo is required if project is research and involves human subjects regardless of the CDC staff role.
Instructions:
(1) Use this form to declare: (a) the research status of anY, project, (b) role or roles of CDC staff

(2) A short summary should be attached offering specific details about the project and the role of staff.
(3) Be sure to complete all applicable items, obtain appropriate signatures and submit this form for approval.

Tracking Number:
(Use PGO number if cooperative agreement, grant, etc.)
Date submitted:

06/12/2019

Title of Project:

Templates for extramural Data Management Plans

Dates for project period:
Beginning:

Dates for funding (if applicable):
Beginning:

01/01/2020

Ending:

Ending:

Project is (choose one):
NOTE: Revision, as used below, refers to any substa111ive change made to the project including scope of project, funding res frictions,
personnel, role of CDC staff member, determination o_fresearch status, etc.
[X)

New

[]

Continuation, without revision(s)

Lead staff member:

Name:

Contact information:

Rachel Kaufmann

Division:

---------Scientific Ethics number:

User ID:

RBK8

I.

Revision

[l

Continuation, with revision(s)
Please indicate your role(s) in this project:

OD

Telephone: 404-498-2347

7214 Mailstop:

[l

[I

Project officer

[X]

Technical monitor

[l

Principal
investigator
Consultant

[I

Investigator

[l

Other (please explain)

[l

S107-8

Are any or all of the activities within this project DESIGNED to contribute to generalizable knowledge (i.e., research)?
[)

YES

[X]

NO

IfYES, list those activities which are research:
2.

Is this CDC project research or public health practice (check all that apply)?
[]

Research
Check one:

3.

[l

Human subjects involved

[l

Human subjects not involved

[X]

Public health practice
Check all that apply:
[)

Emergency Response

[)

Program evaluation

[X]

Surveillance

Other (please explain)
This is an
administrati
ve task:
Collection
of data
manageme
nt plans
from CDC
funding
awardees.
If RESEARCH involving human subjects, has the project or research activities been reviewed by the CDC IRB for human
subjects protection?
a. [] NO, New project, not yet reviewed
d. [) YES, Reviewed and approved by CDC
b. l ] NO, Existing project, not ready to submit
lfYES, please list protocol number_and
c. l ] NO, Submitted for approval

Form 684R_NR (revised January 2003)
ID:

33912

[I

expiration date