ACTRI BERD Services Request Form

ACTRI BERD Services Request Form
Biostatistic Support

Please contact the BERD team (actri-berd@health.ucsd.edu) for any questions prior to submitting your request. For more details on Biostatistic services, click here.
Service Type(s):*

Pre-Award Support [details]Post-Award Support [details]
Please read and acknowledge the Biostatistics Service Level Agreement (SLA).*

I confirm that I have read the [SLA] and agree to its terms
Pre-Award Support Services:*

Grant proposal w/o sample size calculationGrant proposal w/ sample size calculationStudy design, statistical analysis planIRB applicationLetter of supportScientific ReviewOther
Please select your grant type:

NIH R/P/U series (e.g. R01, R21, P01, U01)NIH K/F series (e.g. K01, K99)VA career development award (e.g. CDA-1)VA merit review awardDoDFoundation/Association awardOther
Post-Award Support Services:*

Power and sample size calculation OnlyData analysis and interpretationManuscript review and preparationPoster review and preparationAbstract review and preparationResponse to reviewersGeneral statistical advice/ consultationOther
Deadline type:*
Please provide your external deadline (such as grant or abstract submission deadline):*

MonthDayYear
Date
Have you previously corresponded with the BERD on this project and did they prompt you to submit this request?*

YesNo
6 Weeks are required to be able to complete the requested work. Please reach out to actri-berd@health.ucsd.edu if you would like some help planning next steps for your project. Alternatively, BERD team offers free walk in office hours durring the week. Click here if you would like more information.

-- Study Section
Study Information
Study Title:*
Study Documents

Please provide any documents that can help with this request
Cancelof
Please indicate ACTRI membership level:*

General (existing or pending)Associate (existing or pending)Affiliate (existing or pending)No membership / Don't know.
If you are not an ACTRI member yet, please click here to review membership eligibility criteria and submit your application. Once submitted, please select the applicable membership level from the above options to proceed.

-- Recharge Section
Recharge Information

Please provide valid fund manager and OFC chartstring information for recharge purposes.

Click here to review current ACTRI recharge rates.
Fund Manager Name:*

First NameLast Name
Fund Manager Name:*
First Name
Last Name
Fund Manager Email:*
example@example.com
OFC Project:*
Always required! (7 digit numerical value)
OFC Task:*
Always required! (1-3 digit numerical value)
OFC Funding Source:
Required for sponsored projects only! (5-7 character alphanumerical value)
Award #:
Providing incorrect or incomplete OFC chartstring information will require further clarification and delay the process! Contact your fund manager or use the chartstring verification tool (requires VPN connection) to ensure chartstring accuracy prior to submission.

-- Submit button

-- Submission Section
Current Date

MonthDayYear
Date
Six Weeks From Today

MonthDayYear
Date

-- Integration Utility Section
Service Type(s):
Services Needed:
Voucher Request (Yes/No)
Method of Recharge (Text)
Grant Type
CTRI ORS Email (For Harvest Purposes)
Finance PI LN, FN
Contact Name
Finance Contact LN, FN
Fund Manager Name
Finance Fund Manager LN, FN
Should be Empty:

ACTRI BERD Services Request Form

Biostatistic Support

Study Information

Contact Information

Recharge Information