NIH Disaster Research Response

Data Collection Tools & Resources Form for DR2 and PhenX Repositories

Instructions

To suggest tools and related study protocols and other associated materials for inclusion in NIH Public Health Emergency and Disaster Research Response (DR2) Data Collection Tools & Resources Repository, enter the following information into this intake form (Fields listed with an asterisk are required fields). By submitting this information, you are indicating that you are authorized to make this COVID-19 data collection tool publicly available on the DR2 and PhenX repositories. Your suggestions will be reviewed for relevancy and curated if selected for inclusion. Thank you for helping to build the repository!

Title (Include the title of the tool and a subtitle, if applicable. Do not begin the title with “A, An, or The.)

Subtitle

Format (Use either “PDF” or “Text” [MS Word]. If the format is different from the two options listed, then select N/A.)

Date Tool First Administered (Indicate whether the tool has been administered and, if administered, indicate date of first administration. Use the format YYYY or MM/YYYY or MM/DD/YYYY. If there is doubt as to the date, or if the tool has not yet been administered leave cell blank.)

Description (Provide a short summary description of the tool. Information to provide, if available, may include date of creation, when, where and how the tool has been used, unit of analysis [individual, household, worksite, etc.], domestic or international use, special populations, validation, and any other relevant information. For an example of a well-resourced description, see the University of Miami's IPHCPS record in DR2.)

Questions Adapted From (If your questionnaire is taken from other sources, please list questions and source of question [ex. Q1-Q4 is taken from CDC CDE, Demographics module is taken from NHANES, etc.].)

Population (Select All That Apply by clicking in the box below)

Other Population (Please enter the Population that is not available in the Population Selection List.)

Length (Include the number of items/questions within the tool.)

Time to Complete (Provide an estimation of the time burden. Insert the expected time to complete the tool in minutes or hours.)

Mode of Administration (Select All That Apply by clicking in the box below)

Administered By (Select All That Apply by clicking in the box below)

Special Considerations for Administration (Take note of any special considerations for administration. For example, the following note was provided for the Hamilton Depression Rating Scale [HAM-D]: “While the original scale required a trained clinician to administer the interview, structured and semi-structured interview-versions now exist so the HAM-D can be administered by interviewers without backgrounds in psychiatry.”)

Languages (Always list English. If there are additional languages to which the tool has been translated, list those languages with commas to separate.)

COVID-19 Main Topics (Select topics that correspond with sections of your tool. Select All That Apply by clicking in the box below. To be completed when submitting COVID-19 tools only.)

Other COVID-19 Main Topic (Please enter the Topic that is not available in the Covid-19 Main Topics Selection List.)

URL (Provide tool URLs, if available. If no URL is available, please upload tool documents. Enter multiple URLs [separated by comma] for multiple modules or one URL for full survey. If other study materials are available such as biospecimens/sample collection protocols or instructions, manuals of procedures, IRB research protocol, data dictionary etc., please enter URLs here.)

Availability (Most tools in the DR2 repository are free and publicly available. However, if there are costs or any special permissions are required prior to the use of tool, please indicate here.)

Citations (Provide citation if available.)

Contact Information and Original Source (Provide the contact information for the tool. For example, institution name, contact name and email address. If different than contact information, provide the name of the organization that initially developed, sponsored and/or published the submitted tool.)

Are you submitting this for:Your Self?The Tool Developer?

Submitted By

Upload the Survey Instrument

Upload other study materials, such as biospecimens/sample collection protocols or instructions, manuals of procedures, IRB research protocol, data dictionary etc. here.

Cancel

By submitting this information, you are indicating that you are authorized to make this COVID-19 data collection tool publicly available on the DR2 and PhenX sites

If you need help with submission contact us at dr2@niehs.nih.gov