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.

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

Required format:

koHrBdYMmQsZjaePM7FNzwwVLhcWTpDTjgnGYVB8zbXWZavKVNEMICzdZNZYKVtsT2UICFXg

Data System Services Group - Request for Quotes - UCSF Department of Epidemiology and Biostatistics

Thank You. . .
for your interest in collaborating with the Data System Services Group.

Please fill out the following questionnaire as thoroughly as possible so that we can provide you with an accurate quote for your project. The answers to these questions directly affect the cost estimate. If the scope of the project changes substantially, please resubmit this questionnaire to obtain an updated quote. Please feel free to include any other supporting documents, such as drafts of data forms or a measurement schedule table.

Name of study (or working title):

* must provide value

Name of Principal Investigator:

* must provide value

E-mail address for Principal Investigator:

* must provide value

Telephone number for Principal Investigator:

* must provide value

Name of Project Director:

* must provide value

E-mail address for Project Director:

* must provide value

Telephone number for Project Director:

* must provide value

Name of Data Manager (if known):

Date funding application/grant proposal to be submitted:

M-D-Y

Estimated date of award:

M-D-Y

Awarded period of performance (award date through end of award):

Number of participants/patients to be screened:

Total number pages for screened participants/patients (one page to contain no more than 15 variables; for example, "date" counts as 3 variables...month, day, and year):

Number of participants/patients to be enrolled:

Total number pages for enrolled participants/patients (one page to contain no more than 15 variables; for example, "date" counts as 3 variables...month, day, and year):

Average # of pages per enrolled participant per year:

Preferred mode of data input/entry:

Web-based

Scan

Fax

Combination of web-based and scan/fax

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Please provide details about mode of data input/entry:

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Will there be any other data for this study that will be electronically transferred to the UCSF Data System Services Group and ultimately integrated into the main study database (for example, inventory data from a biospecimen repository, CATI data from a survey research center, or ECG data that is electronically captured by the ECG machine?)

Yes

Not sure/Don't know

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Please note the number of other sources of and describe the type of data:

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Will the data collection forms need to be in any language other than English?

Yes

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What languages? (Note: The DSS does not provide translation services. Translated forms must be identical in content to the English version.)

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Is this study a clinical trial?

Yes

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What phase?

Number of domestic recruitment sites:

Number of international recruitment sites:

Total number of recruitment sites:

When will data collection start?

M-D-Y

When will data collection end?

M-D-Y

When will data be locked (no further changes)?

M-D-Y

Administrative features

Posting of documents/PDFS on internal study website

Directory of staff/investigators phone numbers

Listing of scheduled conference calls with dial-in numbers

Archive of study memos

Reports:

Adherence/Compliance with Intervention report

Screening: Number screened by site. summary

Screening: Number screened by age, gender

Screening: Number screened by ethnicity

Screening: Number of screen failures, by site

Screening: Reasons for screen failures, by site

Screening: Other (Please specify)

Recruitment: Number recruited by site, summary

Recruitment: Number recruited by site, by month

Recruitment: Number recruited by age, gender

Recruitment: Number recruited by ethnicity

Recruitment: Other (Please specify)

Retention: Number of visits/contacts completed, by type of contact and site

Retention: Number of missed visits/contacts by age, gender

Retention: Number of missed visits/contacts by ethnicity

Retention: Reasons for missed visits/contacts

Visit Scheduling Report

Please specify other type of Screening report:

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Please specify other type of Recruitment report:

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Other features:

Randomization tools

Adverse Events/Serious Adverse Events tracking system

Endpoint/outcomes adjudication tracking system

Invoice/Payment tracking system

Publication tracking

Medication coding

HelpDesk

Q and A feature

Secure data storage

Access to statistical software, such as SAS, R, etc.

ODK server set-up

Consultation with Project Director regarding study and data form design

Consultation with Data Manager regarding data queries

Other

Please specify other feature needed:

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How long will the study data need to be archived after the study ends?

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.