Application form to use CHMS biospecimens

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Please fill out the application form (DOC, 131.5 KB) and submit it by e-mail to the CHMS biobank coordinator.

Researchers must provide the following information in their application form to use Canadian Health Measures Survey (CHMS) biospecimens in order for Statistics Canada to conduct a feasibility review. The form will be protected once completed.

  1. Project title
  2. Sample series of biospecimens requested
    • Specify cycle (s)
    • Matrix or matrices
    • Age range
    • DNA quantity (if applicable) in µg
  3. Plain language summary (150 words maximum).
  4. Background and relevance to public and population health (1,500 words maximum)
    1. Introduction and rationale of proposed project
    2. Research objectives and hypotheses
    3. Public health significance
    4. Value added using Canadian Health Measures Survey (CHMS) biobank specimens
  5. Methods (1,500 words maximum)
    1. Population of interest (age group, sex, etc.) and sample size (full sample or targeted subsample)
    2. Analytes of interest and their storage stability in the matrix requested
    3. Techniques and equipment for analyses
    4. Quality Control Strategy
    5. Potential problems, limitations, alternative strategies and/or benchmarks of success for laboratory analyses (if applicable)
  6. Data analyses (1,500 words maximum)
    1. Variables of interest from CHMS data files
    2. Specific details about comparisons and statistical analyses
    3. Survey weights required for analyses (specify if full sample weights, subsample weights, or new weights required)
  7. Publication venues (i.e., dissemination plan)
  8. Planned source(s) and amount(s) of funding, and status of funding (no funding is available from Statistics Canada)
  9. Status of the Research Ethics Board review
  10. Status of peer review (if not conducted by funding body)
  11. Peer reviewers
  12. Principal investigator
    • Family name
    • Given name
    • Initial
    • Position and address
  13. Research team member(s). Provide name, position, address and describe each team member's role and contribution to the project
  14. Project timeline (provide details)
    • Start date (yyyy/mm)
    • End date (yyyy/mm)
  15. Research location
    1. Address of laboratory (i.e., where samples will be analysed).
    2. Preferred Statistics Canada Research Data Centre (i.e., where data will be analysed)
  16. Collaboration(s)
  17. Declare any conflicts of interest
  18. How did you find out about the CHMS biobank call for proposals?
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