Data and/or Material Transfer Agreement Questionnaire

Before sending data and/or materials to any third party, including NEIDL or BU, or when receiving data and/or materials from a third party pursuant to a data transfer or material transfer agreement, please (1) complete the below, (2) attach any template agreements that have been provided for review and a list of data variables, as applicable and (3) send to DUA.MTARequest@bmc.org.

1. REQUEST SUMMARY


(please include description of approvals already received, e.g., IRB, COVID Human Subjects Research Committee, etc.)
b. Name of Requesting BMC Principal Investigator (“PI”) of the Associated Research Project







h. Purpose


2. EXTERNAL PARTY(IES) INFORMATION





3. TRANSFER DETAILS











4. AGREEMENT DETAILS






5. TYPE OF DATA OR MATERIALS

a. Describe the data and/or materials being sent or received.


ii. Materials. If materials, please describe or attach description.







b. Source of Data / Materials. 

i. Please (1) provide the BMC IRB # for any study under which the data/material was collected or will make use of the data / material and (2) indicate whether the data or materials were obtained pursuant to a signed participant consent form.

6. OTHER