United Network for Organ Sharing Sample Clauses

United Network for Organ Sharing. Requester must provide proof of UNOS data approval & patient identifiers to link with USRDSID Requester Signature (for the Institutional Official for Data Assurance) Authorized Signatory (Printed name, title & date) Requester Address Requester Telephone Number Read and Acknowledged (for Primary Investigator and all co-investigators who will analyze data directly) Investigator / Analyst signature Name Date Investigator / Analyst signature Name Date Investigator / Analyst signature Name Date Investigator / Analyst signature Name Date (Attach additional signature pages as necessary) USRDS Contracting Officer Representative: Xxxxx X. Xxxxxx, MD, NIDDK, NIH USRDS Contracting Officer Representative Signature Date Checklist: DID YOU REMEMBER TO: ☐ Signed copy of your institutional IRB approval memo ☐ Copy of your project proposal in recommended format at xxxxx://xxx.xxxxx.xxx/for-researchers/standard-analysis-files/ ☐ Copy of this Data Use Agreement signed by your institutional official, PI, and all active participants. Send ALL documents (including the research protocol) in PDF format and submit documents to XXXXX@XXXXX.xxx. Please note that any MODIFICATIONS or AMENDMENTS require a modification of the existing DUA or a new DUA if the aims of the project are changed substantially, regardless of whether the new aims or projects require additional files. In addition, a new IRB approval memo, new project proposal or copy of the original project proposal with additional analyses/extractions highlighted, and a new signed Data Use Agreement (bulleted items listed above) are required. Investigators may not have more than 5 active Data Use Agreements concurrently and may not request more than one data merge per DUA per year.
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United Network for Organ Sharing. Requester must provide proof of UNOS data approval & patient identifiers to link with USRDSID Requester Signature (for the Institutional Official for Data Assurance) Authorized Signatory (Printed name, title & date) Requester Address Requester Telephone Number Read and Acknowledged (for Primary Investigator and all co-investigators who will analyze data directly) Investigator / Analyst signature Name Date Investigator / Analyst signature Name Date Investigator / Analyst signature Name Date Investigator / Analyst signature Name Date (Attach additional signature pages as necessary) USRDS Contracting Officer Representative: Xxxxx X. Xxxxxx, MD, NIDDK, NIH, Xxxxx.xxxxxx@xxx.xxx USRDS Contracting Officer Representative Signature Date Checklist: DID YOU REMEMBER TO SEND: ☐ Signed copy of your institutional IRB approval memo ☐ Copy of your project proposal in recommended format at xxxx://xxx.xxxxx.xxx/media/1263/outline-for-research-proposals-using-usrds-data.pdf ☐ Copy of this Data Use Agreement signed by your institutional official, PI, and all active participants. Please note that any MODIFICATIONS or AMENDMENTS, regardless of whether they require additional files, require a new IRB approval memo, copy of the original project proposal with additional analyses/extractions highlighted, and a new signed Data Use Agreement (bulleted items listed above). Please send ALL documents (including the research protocol) in PDF format AND consolidate all files into a single PDF file (using the “PDF Portfolio” feature in Adobe) when sending to the NIDDK.
Sample 1
United Network for Organ Sharing. Requester must provide proof of UNOS data approval & patient identifiers to link with USRDSID IMPORTANT! Specify: ☐Data ONLY on matched patients OR ☐Complete SAFs, including matched and unmatched patients ___________________________________________________________________________________________________________ Requester Signature (for the Institutional Official for Data Assurance) ___________________________________________________________________________________________________________ Authorized Signatory (name, title & date) ___________________________________________________________________________________________________________ Requester Address ___________________________________________________________________________________________________________ Requester Telephone Number Read and Acknowledged (for Primary Investigator and all co-investigators who will analyze data directly) ___________________________________________ _____________________________________ _________________ Investigator / Analyst signature Name Date ___________________________________________ _____________________________________ _________________ Investigator / Analyst signature Name Date ___________________________________________ _____________________________________ _________________ Investigator / Analyst signature Name Date ___________________________________________ _____________________________________ _________________ Investigator / Analyst signature Name Date (attach additional signature pages as necessary) USRDS Project Officer: Xxxxx X. Xxxxxx, MD, NIDDK, NIH, Xxxxx.xxxxxx@xxx.xxx USRDS Project Officer Signature Date Checklist: DID YOU REMEMBER TO SEND: ☐ Signed copy of your institutional IRB approval memo ☐ Copy of your project proposal in recommended format at xxxx://xxx.xxxxx.xxx/2017/appx/3/Outline_for_Research_Proposals_Using_Merged_USRDS_Data.pdf ☐ Copy of this Data Use Agreement signed by your institutional official, PI, and all active participants. Please note that any MODIFICATIONS or AMENDMENTS, regardless of whether they require additional files, require a new IRB approval memo, copy of the original project proposal with additional analyses/extractions highlighted, and a new signed Data Use Agreement (bulleted items listed above). Please send ALL documents (including the research protocol) in PDF format AND consolidate all files into a single PDF file (using the “PDF Portfolio” feature in Adobe) when sending to the NIDDK.
Sample 1

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