The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

NYC Health + Hospitals CTSI Service Request Form

Returning?

A A A

The NYU-NYC Health + Hospitals CTSI supports clinical and translational research that transforms health care and improves community health. The H+H CTSI service request process includes a consultation to discuss your project and specific needs. The initial consultation and ten hours of work are provided for free; this typically applies to straightforward requests (e.g., aggregate data for grant proposals, one-time data requests for commonly used variables). Complex data requests or ones that require more than one data set will be billed at the rate of $75 an hour.

....

Please note the following requirements and timelines when submitting a request:

Prospective research (e.g., clinical or intervention trials) requires consultation with the H+H CTSI at least two months in advance of grant submission and ideally during the proposal development/planning phase. We may not be able to provide data for funded projects if the project has not been discussed with us prior to submission.

Retrospective analyses that require data for facilities beyond Bellevue require consultation with the H+H CTSI before a protocol is submitted to the NYU IRB. For analyses that have already been approved by NYU, we are only able to provide the data specified in the protocol and we may not be able to provide all requested variables.

Requests for preliminary data for grant proposals require at least four weeks' notice. If the research outlined in the proposal requires H+H data beyond Bellevue, the H+H CTSI must be contacted in the initial phases of proposal development.

....

Please note that not all requests can be filled and that data requests may only be partially filled, especially if they are not submitted in accordance with the guidelines and timelines noted above.

....

We will respond to complete requests within one week of receipt. Retrospective data requests that are submitted without a completed data specification sheet will not be reviewed.

....

Requests for commonly used variables/data sources (e.g., diagnoses, visit and discharge dates, demographics, visit payer) typically take 4-6 weeks to complete; requests that require additional data (including labs, procedures, and medication orders) and/or multiple data sets will take longer to complete. Please also note that data needed for time periods prior to H+H's transition to the Epic EHR system requires additional time and may not be accessible due to a discontinuation of support for the previous EHR system.

....

If you have any additional questions, please email us at CTSI_Research@nychhc.org

....

Please review the following guide before submitting a service request.

H+H CTSI Guide for Collaborative Research - 2023

Attachment:H-H CTSI Research Guide for NYU Researchers - 2023.pdf

Full Name

* must provide value

Title

* must provide value

Institution

* must provide value

Department or Facility

* must provide value

Phone

* must provide value

Is requester the PI?

* must provide value

Yes

reset

PI Full Name

* must provide value

PI Title

* must provide value

PI Department/Facility

* must provide value

PI Email

* must provide value

PI Phone

* must provide value

Purpose of data request (Please check all that apply)
Please note that starred items below require consultation with the H+H CTSI before submitting a protocol to an IRB, submitting grant applications, and/or award of funding to ensure that the H+H CTSI can provide the requested services or data.

* must provide value

Data for grant application

Prospective research (Bellevue only)*

Planning/preparation for prospective research at H+H facilities

Retrospective data analysis (Bellevue only)

Retrospective data analysis (Bellevue and/or other H+H facilities)*

Other

Funding Agency

Grant #

If other, please describe

* must provide value

Deadline for receipt of data

* must provide value

M-D-Y

Brief description of Research (background, objectives, methods, specific aims, etc.)

* must provide value

Expand

What is the available/maximum budget allocated for this data request?

* must provide value

Have you discussed this project with any NYC Health + Hospitals staff?

* must provide value

Yes

reset

Who have you discussed this project with at NYC Health + Hospitals?

Name

* must provide value

Facility

* must provide value

Name

Facility

IRB Affiliation

IRB #

IRB Determination

Expand

Not under IRB purview? (please explain)

Expand

Protocol

Upload file

IRB Determination

Upload file

STAR determination

Upload file

Download and complete the following data request specification template. The completed form should be saved with the following file name format and then uploaded in the section below.

[PI first] [PI last] - [Subject/study name] Data Request - [MM.DD.YYYY]

Requests submitted without a completed data request specification form will not be reviewed.

[Attachment: "H+H CTSI Data Specification Form.docx"]

Attachment:H+H CTSI Data Specification Form.docx

NYC H+H CTSI data request specifications

* must provide value

Upload file

Have you already completed a data order form for this study?

* must provide value

Yes

reset

PHI data order form

Attachment:PHI Data Set Order Template (H+H-NYUSoM Master Data Confidentiality Agreement 22July2020.docx

*REQUIRED: You must include the funding source on all publications: "Supported in part by the NYU CTSA grant number UL1TR001445 from the National Center for Advancing Translational Sciences (NCATS), NIH."

NYC H+H - NYU SOM Master Data Use Agreement

Attachment:MasterDUA HHC-NYUSoM (effective 1-1-16).pdf

You acknowledge that:

You have reviewed the Master Data Use Agreement.
Any data received from NYC Health + Hospitals for research will be used in compliance with the terms of the NYU/NYC Health + Hospitals FY 2016-2020 Affiliation Agreement and NYC Health + Hospitals Human Subject Research Protections Program Policies and Procedures ("O.P.').
You are required to follow all appropriate rules related to data security and confidentiality as outlined in the Master DUA and IRB notification.
The IRB you are using for research is either designated under NYC Health + Hospitals Federalwide Assurance (FWA) or that the IRB is FWA compliant, if applicable.
Any research involving data provided by NYC Health + Hospitals may not begin without the prior written approval of the NYC Health + Hospitals' Office of Research Administration, if applicable.
You must provide NYC Health + Hospitals a copy of any publication/presentation before publishing or presenting so that NYC Health + Hospitals may comment. NYC Health + Hospitals will review, as stated in the O.P., within 30 days.
For any research conducted using data provided by NYC Health + Hospitals you must request continuing approval of the research as stated in the O.P, if applicable.
It is your obligation to acknowledge NYC Health + Hospitals' research support and contributions in all publications and presentations as stated in the O.P.

NYC Health + Hospitals will acknowledge receipt of data requests within one week. Estimated time to fulfill data requests will vary depending on the complexity of the request and the number of concurrent requests. NYC Health + Hospitals will keep researchers informed of the status of requests and provide regular updates.
Researchers are expected to engage with NYC Health + Hospitals subject matter experts on data analysis/interpretation, grant proposals, conference presentations, and publications.
Researchers are expected to provide to the NYC H+H CTSI updates, when requested, on the status of data analysis, grant proposals, conference presentations, and publications.

Name

* must provide value

Signature

* must provide value

Add signature

Date Signed

* must provide value

M-D-Y

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.