Completing an Institutional Certification Form

Find step-by-step instructions for completing an Institutional Certification form. Want to learn more about Institutional Certifications? See About Institutional Certifications.

Step 1: Download Institutional Certification Forms

NIH provides different versions of the Institutional Certification based on 1) the type of research funding and 2) whether samples were collected before or after the effective date of the GDS policy. Please note that the downloadable forms work best if completed in Adobe.

Extramural (Grants & Contracts)
Type of Institutional Certification Form Downloadable Forms
Sample collected AFTER Jan 25, 2015 Download form
Sample collected BEFORE Jan 25, 2015 With Consent - Download form
Without Consent - Download form
Provisional (IRB or equivalent body has not yet completed review) Download form
NIH Intramural (NIH Staff Only)
Type of Institutional Certification Form Downloadable Forms
Sample collected AFTER Aug 31, 2015 Download form
Sample collected BEFORE Aug 31, 2015 With Consent - Download form
Without Consent - Download form

Step 2: Study Information

The initial part of the Institutional Certification form asks for some basic information about the study and the performing institution(s).

  • Name of the NIH Genomic Program Administrator (GPA)
    • The genomic program administrator (GPA) at the NIH IC funding the project, or at the IC most closely aligned with the project.
  • Name of institution
    • The name of the institution submitting the certification.
  • Original study name
    • The original institutional review board (IRB or equivalent body)-approved study under which the participants provided informed consent and the specimens were collected.
  • Project title for data to be submitted
    • The name of the research project. It may or may not be the same as the original study.
  • Collaborating sites
    • The collaborating sites that this Certification will cover (only applicable to multi-site studies).
      • Click “add to list” after entering each site. This will allow the form to generate a list of all the collaborating sites, which will automatically fill out the “list of collaborating sites” field.
      • If necessary, click “clear list” to delete all the collaborating sites and start over.

Step 3: Assurances

In this section, the institution, in consultation with its IRB or equivalent body, assures NIH that the study being submitted is consistent with the NIH GDS Policy, and with the informed consent of the original study participants. Learn more about assurances in the "What are Institutions Expected to Certify? Elements of an Institutional Certification" section of our About Institutional Certifications page.

Step 4: Restrictions: Controlled Vs. Unrestricted Access

In this and the following section, the Institutional Certification can specify any applicable limits on how the genomic and phenotypic data may be shared and who may access the data. The appropriate limitations are decided by the submitting investigator and their institution, in consultation with the IRB or equivalent body. Data use limitations (and modifiers) should be based on language in informed consent forms and any additional considerations to maximize protection of participants or special knowledge of the original study population that an IRB deems necessary for protecting participants. NIH provides considerations for IRB and institutions to refer to when completing Institutional Certification forms.

Whenever possible, NIH strongly encourages investigators to use human genomic data generated from participants who gave consent for unrestricted access, or who gave consent for General Research Use (see table below) under controlled access. Similarly, NIH encourages consent language to avoid restrictions on the types of users who may access the data. This will maximize the potential for important research and public health impacts.
Dataset Access
  • The informed consent under which the data or samples were collected determines whether the submitted data should be available through an unrestricted or a controlled access repository.
    • Data in controlled access databases are available to investigators only after review of their proposed research use. Data in unrestricted access databases are publicly available to anyone.
Access to Genomic Summary Results (GSR)

Step 5: Restrictions: Data Use Limitations (DULs)

Standard DULs and DUL modifiers should reflect the informed consent from the participants and/or the preferences of the original study population or if after IRB or equivalent review, research use limitation is deemed necessary. For more information, refer to "Points to Consider in Developing Effective Data Use Limitation Statements".

Standard Data Use Limitations
Data Use Limitation Description
General Research Use (GRU) Use of the data is limited only by the terms of the Data Use Certification.
Health/Medical/Biomedical (HMB) The dataset can only be used for studying health, medical or biomedical conditions, and does not include the study of population origins or ancestry.
Disease-specific (DS) The dataset can be used only for research on a specific disease or related condition.
Data Use Limitation Modifiers (Optional)
  • If appropriate, indicate any necessary modifiers to the standard DULs.
Data Use Limitation Modifiers Description
IRB Approval Required (IRB) The requesting institution's IRB or equivalent body must approve the requested use.
Publication Required (PUB) The requestor must share their results with the larger scientific community.
Collaboration Required (COL) The requestor must provide a letter of collaboration with the primary study investigator(s).
Not-for-profit Use Only (NPU) The dataset can only by used by not-for-profit organizations. State specifically if the data should not be made available to commercial organizations.
Methods (MDS) The dataset can be used for methods research and development (e.g., development of statistical software or algorithms).
Genetic Studies Only (GSO) The dataset can only be used only for genetic studies.

Step 6: Signatures

In the final section, the project investigator and their institutional signing official certify that this form has been reviewed by an IRB (or equivalent body) and/or other senior institutional officials, and that all parties agree that this submission meets the requirements of the form.

  • Investigator name
    • The investigator at the certifying institution
  • Title
    • The title of the signing investigator
  • Institutional Signing Official (SO)
    • A senior official at an institution who is credentialed through the NIH eRA Commons and is authorized to enter the institution into a legally binding contract.
    • For intramural research projects, the SO is the IC's scientific director or their designee.

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