Key
bold item is added or changed
strike through item will be removed, but currently exists
blue text is the type of form field used online, and also says something about the type of db field
Contact Information
First name: text field: single line will pull data from current db
Last name: text field: single line will pull data from current db
Organization (i.e., C/I/O): text field: single line will pull data from current db
Primary Phone: text field: single line will pull data from current db
Primary E-Mail: text field: single line will pull data from current db
Receive notifications? Checkbox New field
Secondary First name: text field: single line New field
Secondary Last name: text field: single line New field
Secondary Organization (i.e., C/I/O): text field: single line New field
Secondary Phone: text field: single line New field
Secondary E-Mail: text field: single line New field
Receive notifications? Checkbox New field
Please list names and email addresses of your team members who will require access to the requested lab resources:
Group name text field: single line {this field is admin only] New field
Name New field Email New field Username {this field is admin only] New field
text field: single line text field: single line text field: single line {this field is admin only]
text field: single line text field: single line text field: single line {this field is admin only]
text field: single line text field: single line text field: single line {this field is admin only]
Add more button
IIU Services Requested
Would you like to use 1 or more virtual computers (VM's) running in the Public Health Informatics Research Cloud? Radio buttons: Yes No New field
Would you like to use the Physical Collaboration space in 2500 Century Center?: Radio buttons: Yes No will pull data from current db
If yes, how many simultaneous physical workstations (lab seats) do you require at one time? (spin box - max 18) will pull data from current db
Would you like to have a consultation session with IIU's Innovation team?: Radio buttons: Yes No will pull data from current db
If yes, please describe what you would like to discuss: text box: multi-line New field
Would you like access to test out specific hardware (e.g., mobile device)?: Radio buttons: Yes No New field
Project Details
Project Title/Name: text field: single line will pull data from current db
Requested Start Date: text field: auto calendar New field
Requested End Date: text field: auto calendar New field
Approved project Start Date: text field: auto calendar {this field is admin only] will pull data from current db
Approved project End Date: text field: auto calendar {this field is admin only] will pull data from current db
Project Type: 3-item drop-down list {this field is admin only] Choices: Prototype, Evaluation, Hybrid will pull data from current db
Project Use: 3-item drop-down list {this field is admin only] Choices: Internal, External, Collaborative will pull data from current db
We can best help you meet your needs if we have a general understanding of your project. Please help us frame your project by addressing the following questions. Even if you are only requesting use of the physical laboratory space, a project summary will allow us to potentially leverage other R&D technology initiatives in working with you.
Project Summary: text box: multi-line will pull data from current db
Project Goals: text box: multi-line will pull data from current db (vision)
Project Success Criteria: text box: multi-line will pull data from current db (metrics)
Project Stakeholders:
Who are the stakeholders (users/actors) in your proposed engagement? Please list key technology users, data suppliers, report recipients, as well as any applicable governing guidelines (e.g., HIPAA).
Stakeholder*# will pull data from current db Role** will pull data from current db
text field: single line text field: single line
text field: single line text field: single line
text field: single line text field: single line
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*Organization, C/I/O, user group, individual, etc. **e.g., User, data supplier, report recipient, governing body. #Please note that you can choose more than one role per stakeholder.
Technology Requirements
The Lab has defined a set of core technology standards which can be quickly installed as a default (i.e., not otherwise specified). Please modify as needed for your specific project requirements. Please list specific software needed in the Notes section.
Computing Resources
Resource Type 1: Virtual Computer (VM)
VM Configuration: Drop-down select (LIST PROVIDED BY DALE) - example: Windows7 desktop, Windows Server 2008, SQL Server, CentOS, etc.
will pull data from current db (OS)
Notes: text box: multi-line will pull data from current db
VM name: text field: single line {this field is admin only] New field
Internal Notes: text box: multi-line {this field is admin only] New field
Proxy from: text field: single line {this field is admin only] New field
Proxy to: text field: single line {this field is admin only] New field
Add More: button: will add another set of fields like above
VM Request Details:
Will any of your requested VMs run services which will need external lab access (e.g., a publicly available web site)?
Radio buttons: Yes No will pull data from current db
If yes, please provide details: text box: multi-line New field
Will any of your VMs connect to non-production systems/databases OUTSIDE CDC? Radial buttons: Yes No will pull data from current db
If yes, please provide details: text box: multi-line New field
Will any of your VMs connect to non-production systems/databases INSIDE CDC? Radial buttons: Yes No will pull data from current db
If yes, please provide details: text box: multi-line New field
Resource Type 2: Non-VM (mobile device, etc.)
Device: text field: single line will pull data from current db (OS)
Notes: text box: multi-line will pull data from current db
Add More: button: will add another set of fields like above
Data Resources:
If your project involves the use / testing of data (synthetic data, publicly available, etc.,) please describe the following:
What is/are the primary sources of data, if any, for the proposed technology? Please note that all data sets must be examined (e.g., for privacy & security) prior to loading into the lab environment. The lab can provide synthetic data if necessary.
text box: multi-line will pull data from current db
Will your project require access to any third-party websites and/or applications? Radial buttons: Yes No New field
If yes, please provide details below:
Website New field Description New field
text field: single line text field: single line
text field: single line text field: single line
text field: single line text field: single line
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Please feel free to provide any additional information regarding your technology needs below. text box: multi-line will pull data from current db
Project Status: 9-item drop-down list {this field is admin only] Choices: On Hold, Awaiting Submission, Under Review, Submitted, Rejected, Submitter Revising, Approved, Discontinued, Completed will pull data from current db
Project Status Notes: text box: multi-line {this field is admin only] will pull data from current db
Infrastructure Status: 9-item drop-down list {this field is admin only] Ready, To Set Up, On Hold, Setting Up, Modifying, To Take Down, Taking Down, Removed, Archived will pull data from current db
Infrastructure Status Notes: text box: multi-line {this field is admin only] will pull data from current db
Outcome / Summary / General Notes: text box: multi-line {this field is admin only] will pull data from current db
Please confirm that all the entered information is accurate. Click "Submit" when ready.
Once you have submitted your information, if you need to make changes, please contact the R&D Lab at informaticslab@cdc.gov
Submit button
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