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

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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 North American 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:

9YSUokwniypTin8g5BRpvfHukZKDoiCPn4Ero8MUphwhqIHhFNUdZDjKQWwNkKEMxEGwoMLvpiiWppIN83jeVd2onqaruKPjNIUe

Biostatistics Project Request Form

To request biostatistical support for your project, please complete the form below.

Thank you!

IMPORTANT, the process is now changed.

For all requests, a quote will be provided by the assigned biostatistician and both the PI and Department Chair will have to sign off (acknowledge the request and commit the necessary funds) before the biostatistics support is offered. For the revised workflow, please click here.
For reference purposes, please see a copy of the biostatistics fee schedule here.

By completing this form and providing your attestation at the end of this form, you agree with the terms described.

Designated Contact (Person completing this form): First and Last Name

* must provide value

Designated Contact (Person completing this form): Title

* must provide value

Designated Contact (Person completing this form): Email

* must provide value

Are you also the PI for this project?

* must provide value

Yes

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Principal Investigator: First and Last Name

* must provide value

Principal Investigator: Title

* must provide value

Principal Investigator: Email

* must provide value

Department (if you have multiple HMH affiliations, please select the department/institution and department Chair that are relevant for this project)

* must provide value

Other Department - Please specify

Please make sure you have discussed the specific project with your Department Chair as they will be asked to sign off before services can be provided. Upon submission of this request, your department Chair will be notified and he/she will be notified again if the project requires significant support.

If you are a CDI team member requesting support, please add Alla Rabinovich information in the Department Chair field below (alla.rabinovich@hmh-cdi.org). Thank you

First and Last Name of Department Chair (person that will need to sign off on the project)

* must provide value

Department Chair Email

* must provide value

HMH Institution

* must provide value

Other Institution - Please specify

Please provide details about the research project and the Biostats assistance requested.

Project Title
Please enter "working" project title. (Or the FULL Grant Title, if applicable)

* must provide value

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Abbreviated Title for this project

* must provide value

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Is this a new project?

* must provide value

Yes

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Have you worked with a biostatistician on this project before?

* must provide value

Yes

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Who was the biostatistician you work on this project before?

* must provide value

Type of project

Service requested should reflect the current needs of the project. Separate requests need to be submitted if multiple services are requested over time (e.g. statistical analysis plan requested now and data analysis once data is collected, i.e. 2 requests).

* must provide value

Statistical Analysis Plan (including study design, sample size calculation, statistical methodology and data management plan)

Initial or Exploratory Data Analysis (a report will be provided outlining the analysis conducted)

Data Analysis for specific Abstract / Poster Preparation

Data Analysis for specific Manuscript (if you are planning to work on multiple manuscripts, please submit separate requests for each manuscript)

Manuscript Revision (only for a manuscript already submitted to a specific journal)

Grant/ External Funding Support

Biostatistics Consultation

Other

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If you chose "other" please specify

Was this a manuscript already supported by an HMH biostatistician?

* must provide value

Yes

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Please note, since this is a new project (manuscript not previously support by the HMH Biostat team), the project is billable.

Type of study

Please note, if this project is not research but a QI/QA project, you will need to contact the Institute for Evidence-Based Care for support as QI/QA projects are not supported by the research biostatisticians.

* must provide value

Retrospective chart review

Retrospective database/registry

Prospective database/registry

Prospective observational study

Prospective behavioral study (e.g. surveys, interviews, focus groups)

Prospective interventional study

Clinical Trial with FDA approved drug/device/biologic

Clinical Trial with investigational (non-FDA approved) drug/device/biologic

Other

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If you chose "other" please specify

Please upload your draft protocol, literature review, reference publication or any other document that could facilitate the process.

Upload file

Or provide the link to a sharable version (please make sure you have allowed access)

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Is this an IRB approved project?

Yes

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Please provide your protocol number

Is data collection completed?

Yes

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Name of Conference

* must provide value

Deadline for abstract submission

* must provide value

M-D-Y

Name of Journal

* must provide value

Link to Journal's guidelines/ instructions (please provide the specific guidelines/instructions for the type of the manuscript you are interested in submitting)

* must provide value

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Who is the sponsor of the grant?

NJHF

NIH

DOD

Other federal

Private organization

Industry

Other

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Other - Please specify

Name of Grant/ External Funding Opportunity

Deadline (if applicable)

Please only provide a date if you have an externally imposed deadline.

M-D-Y

Additional Information (as applicable)

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Attestation [If "No" is selected, your request will not be submitted]

1. I have reviewed the provided Biostatistical Fee Schedule, and I have discussed this specific project with my Department Chair.
2. I or my Department have the funds to support the project if needed.
3. I understand, to receive the best support by the Biostatistics team, reasonable time should be provided based on the specific service requested.
4. I understand that last minute requests might only be supported if availability allows.

* must provide value

Yes

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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.