Mandatory Questionnaire – Grants Information and Submission

Principal Investigator's Full Name

Principal Investigator's (PD/PI) Full Name

eRA Commons ID

PI Email *

PI Phone Number

Title of Project

What are the major goals of this project?

Layout

Start Date *

End Date *

Website / URL *

RFA/PA: Please enter a URL Link for your opportunity guidelines:

Application Due Date *

What is the proposal mechanism type?

Type of Application

Please list the Federal Identifier (Example: NS123654)

Will this project occur at more than one location?

Location of Preponderance of work at MGH

Please list percentage for each location

Please list all location and percentage for each site

Is this a Multi-PD/PI Proposal? *

Multi - PD/PI Full Name

Multi - PI E-mail *

Is your agreement a subcontract under another organization's award?

Please list the immediate Sponosr

Please list the Originating Sponsor

Will this project include subcontracts to other institutions?

Please list the SubContract Name

Please list the Subcontract PD/PI Full Name

Subcontract PD/ PI eRA Common ID

Subcontract PI E-mail

Administravtive Contact Full Name

Subcontract Administrative Contact E-mail *

Subcontract Place of Performance

Does this project involve the use of Human Subjects?

Does this project include a clinical trial?

Is the protocol oversight at a Mass General Brigham IRB Office?

Please provide the name of the external Institution that will provide IRB oversight

Does this project include the use of Animals?

Is the protocol oversight at a Mass General Brigham IACUC committee?

Is this a laboratory research project that uses human materials, infectious agents, or biological toxins?

Is this a laboratory research project that uses recombinant or synthetic nucleic acid molecules?

Is this a clinical research project that involves the administration of biohazardous materials to human subjects?

Does this project contain Radiation/Isotope Use?

Please enter a permit #

Is this project Cancer related?

Is this projected related to COVID-19/Coronavirus?

Is the Project Exempt from Federal regulations?

Exemption Number (Please list your number)

What year of your project does the IRB protocol work begin?

Will non-Mass General Brigham’ institutions rely on Mass General Brigham IRB for protocol oversight? (For example, if Single IRB policy applies)

What year of your project does the IACUC protocol work begin?

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Mass General Brigham IACUC Protocol # associated with this record

Please provide the name of the external Institution that will provide IACUC oversight

Has this study been submitted to IBC?

When do you intend to submit to IBC?

Does this project include the use of Human Embryonic Stem Cells?

Does this project involve activities (which would include travel, conduct of research) outside of the United States or in partnership(s) with international collaborators or foreign nationals?

As part of this project, do you intend to transfer/transmit/ship any of the following outside of the country: *

Information/data (other than through publication)
Materials (including biological, chemical, or radioactive samples)
Equipment, software, or technology.

Will any foreign nationals be working on the project (in either a paid or unpaid capacity)?

Does this research project involve extensive foreign travel and/or potentially result in co-authorship with foreign nationals?

Please identify the countries involved in the research project

Please describe the activities outside the United States or in partnership with foreign nationals

To the best of your knowledge, will this project export information, materials or equipment that currently requires licensure under US export control laws?

Does the NIH Genomic Data Sharing policy apply to the proposed research?

Does the proposed research involve Human specimens and /or date, even if considered de-identified? *

Please enter the Statement of Work (SOW) for this agreement. This information is required because this agreement is a subcontract under another organization’s award. This information will be used to generate the Statement of Intent (SOI).

To the best of your knowledge, will this project export information, materials or equipment that currently requires licensure under US export control laws?

What year of your project does the IRB protocol work begin?

U.S. Citizen or Non-Citizen National?

If no, select most appropriate Non-U.S. Citizen option: