Form 1 American Indian Alaska Native Data Use Statement and Progress Report

OMB No: 0925-0780

Expiration Date:10/31/2026

Burden Disclosure Statement

Public reporting burden for this collection of information is estimated to average 60 minutes 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0780). Do not return the completed form to this address.

Research Data Use Statement

Describe the purpose of the scientific investigation, scholarship or teaching, or other form of research and research development for which you are requesting access to data from NIH Brain Development Cohorts. Include detailed information about study aims pertaining to use of data from AI/AN participants, including plans for addressing the AI/AN code of conduct (e.g., engaging AI/AN communities in design, analysis, and communication of research findings), and mitigating risk of harm to individuals and communities (See Term #3). ___________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Renewal Applicants Only:

Researchers who conduct a secondary analysis on shared data, are expected as part of the Terms of Use (above) to report their results (See #14 in the general DUC).

1. Has a publication, computational pipeline, or other public disclosure of results from the analysis of data accessed from NIH Brain Development Cohorts resulted from a Recipient’s previous access period? Note that publication includes preprint services (e.g., PsyArXiv, BioRxiv). Yes: ___ No: ___

If Yes, have the derived data used in disclosure of results been identified? Yes: ___ No: ___

List the Digital Object Identifier(s):

List the PubMed ID(s) or citation(s): ________________________________________________________________________________________________________________________________

2. Progress Report. Recipients requesting a renewal of an expiring A-DUC should provide a Progress Report on research conducted with data from the NIH Brain Development Cohorts Data Sharing Platform. The Progress Report should also describe any updates to the original Research Data Use Statement.

Progress Report Statement: