NAACCR Grant Application Form – NCCR participation and VPR linkage with NCCR

Sample Testing Version

Congratulations! Your registry has qualified for the opportunity listed below.

National Childhood Cancer Registry (NCCR) participation:
(Grant/Award: Funding TBD): To provide data on all childhood cancer cases for compilation into a National Childhood Cancer Registry. Deliverables include the following:

Obtain necessary approvals for release of confidential data to IMS, Inc. (3rd party honest broker)
Submit an annual file of edited, consolidated, de-duplicated, identifiable data on all childhood cancer cases (age 0-19) diagnosed from 1995 to the latest diagnosis year
Include text documentation included in the abstracts from individual reports to support extraction of specific data items (e.g. chemotherapy agents) through the use of national language processing

Linkage with NCCR using the Virtual Pooled Registry (VPR):
(Grant/Award: Funding TBD): To perform annual VPR linkage with the NCCR to help identify subsequent primaries within the NCCR cohort. Deliverables include the following:

Participate in annual VPR linkage between your full registry file and the NCCR cohort file to identify subsequent primaries
Utilize the VPR system and standard protocol for linkage using Match*Pro
Perform manual adjudication of possible matches
Submit data to IMS for incorporation into the NCCR

1. Start Date of Proposed Grant/Award: *This question is required. This question requires a valid date format of MM/DD/YYYY.

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2. End Date of Proposed Grant/Award: *This question is required. This question requires a valid date format of MM/DD/YYYY.

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Applicant Information

3. Program Contact Full Name: *This question is required.

4. Program Contact Position/Title: *This question is required.

5. Program Contact Email: *This question is required. This question requires a valid email address.

6. Program Contact Telephone #: *This question is required.

7. Financial/Administrative Main Contact Full Name: *This question is required.

8. Financial/Administrative Main Contact Email: *This question is required.

9. Financial/Administrative Main Contact Telephone #: *This question is required.

10. Applying Institution/Organization Name: *This question is required.

11. Institution/Organization Type (options included University/Academic, State/Provincial Central Cancer Registry, Other (write in required): *This question is required.

12. Institution/Organization, Complete Mailing Address: *This question is required.

Application Narrative
Instructions: All applicants are required to submit a single application that includes the information requested below.

13. Proposed Plan: Summarize your plan to complete the grant activities and meet the deliverables. Include information about who is responsible for each part of the plan and each deliverable (2-pages maximum) *This question is required.

14. Proposed Timeline: Provide a timeline of when grant activities and deliverables will occur (1-page maximum) *This question is required.

Registry Commitment

I attest that the registry intends to meet the deliverables according to this grant/award opportunity and as detailed in the proposed project plan/timeline *This question is required.

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Signature of

NAACCR Grant Application Form – NCCR participation and VPR linkage with NCCR

Grant /Awards