PI Assessment Form for Category 1 (DURC) or Category 2 (PEPP) Research PI Assessment Form for Category 1 (DURC) or Category 2 (PEPP) Research A separate form must be completed for each grant or project proposal. Contact Information Principal Investigator (PI)PI Name:* First Last PI Phone:*PI Email:* Submitter Name (if different from PI) First Last Submitter PhoneSubmitter Email Project Information Grant or Project Proposal Title Please provide a brief description of the project*Does the project use and/or create a PPP? Yes No Please list Category 2 agent(s) involved:Please select which Category 2 experimental outcomes are anticipated: Enhance transmissibility of the pathogen in humans Enhance the virulence of the pathogen in humans Enhance the immune evasion of the pathogen in humans such as by modifying the pathogen to disrupt the effectiveness of pre-existing immunity via immunization or natural infection Generate, use, reconstitute, or transfer an eradicated or extinct PPP, or a previously identified PEPP None of the above outcomes Please provide rationale as to why or why not your research involves a Category 2 experimental outcome:Does the project involve a listed agent or toxin? Yes No Please list Category 1 agent(s) or toxin(s) involved:Please select which Category 1 experimental outcome(s) occur: Increase transmissibility of a pathogen within or between host species Increase the virulence of a pathogen or convey virulence to a non-pathogen Increase the toxicity of a known toxin or produce a novel toxin Increase the stability of a pathogen or toxin in the environment, or increase the ability to disseminate a pathogen or toxin Alter the host range or tropism of a pathogen or toxin Decrease the ability for a human or veterinary pathogen or toxin to be detected using standard diagnostic or analytical methods Increase resistance of a pathogen or toxin to clinical and/or veterinary prophylactic or therapeutic interventions Alter a human or veterinary pathogen or toxin to disrupt the effectiveness of preexisting immunity, via immunization or natural infection, against the pathogen or toxin Enhance the susceptibility of a host population to a pathogen or toxin None of the above outcomes Please provide rationale as to why or why not your research involves a Category 1 experimental outcome:Funding Source: Federal funds Departmental / Institutional Funds Business/industry Other Other Funding Source If Federally Funded provide agency, agency contact, and grant number:If federally funded, does the notice of award (NOA) include a requirement for IRE review? Yes No N/A If federally funded, the PI has provided a PI assessment to the grant program officer? Yes No Please attach grant application and/or project research description as a PDF.Accepted file types: pdf, Max. file size: 24 MB.EmailThis field is for validation purposes and should be left unchanged.