1 Access Request

The National Institutes of Health (NIH) NeuroBioBank Tissue Access Request and Progress Report Forms

Att 6_NBB Tissue Access Request_Other Funded

OMB: 0925-0723

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Kaltlln Taylor -

NeuroBioBank

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Submit a Request for Tissue Samples
Plannlnt; th� R.nd ol�@r\'ma�les
Is the !'R

Name of funding Aghould be
followed more sirictly ,ind v,hich Qn be followed more toosely. Haa1ing less
strict requirements "Alill nllo•,ifor a widernmee of av,iil�ble specimens.

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Ml;ass Change for Amount Reque5ted

@All Specimens Olly Brain Region

Edit R equested !:ipecimen(s)

El Request Details
llllfl of Re,euch Pl;,n •

Describf! this re,quest, including a summary of the rationale, main hypoth..,;is and proposed research aims•

1-. bnel o�er�e.., ofyot1r research needs.

Describe the assay krt{s)/platform(s:, to be used, if applicable.

Ha\fe you u,ed the proposed methods with human post-mortem tissue?•
Yes
No

Rationale for biospecimensrequested•

Pl�as• prnvifiace soeLi,.,E11S.

Is this a pilot study?*
Yes
No

Will the resulh be u�ed fur a commercial purpo,;e?•

I'. "Yes'" ref;"onsc deftn,,� this .is .i ·commac1.i1 PUrposc·· rc,qucsi,
y��
No

Commenb

/4
NeuroEliQBank D�b :Sh�ring
RM-�archN� conducting ,:,tudi�3 U3ing NcuroB!OBank spccrncns arc rcquircc to �har� their dotn lo lowingthe Fi!ldoblc, Acc-�s �ible, Interoperable, and Rcu�ablc (FAIR) guidelinM of tJIH
D313 IJanaqement 3nd Sharing poli:y. Researchers are stron�ly encouraged to subm� genomic and/or tr3ns<:rip;omic da:a generated from NeuroBioBank specimens to lhe tJeuroBioElank
Data Repcs�oryin MMH DataAfc h ve.
Plea"" attach a CV for the Principal Investigator.•
Whf'n ynu ,att,a�h lhP fi 'P, rlP"s" mr.kf' SLJrf' thf' OnrnmPnt Typ? i� Sf'11n "Prin�ir,al lnwsti9,atnr r.v"

We also encounoge uploading any 2ddtional supporting documentation that is relevam to 1·our tissue reque,1 Uploading supporting documentation for your rationale, power anal11sis,
e:c. may ,mprove request revre1,1 t,mes."

Attach Files
Filfl

Document Type

Principal lm,e,tig,3tor OJ
Attic Power Analys,�
R.iliun�I� Suppurling Du�urmml�liun
Ch l111 dg��
'lou m 0th� Documemrnion

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