**National Institutes of Health**

**RD/HPRD Dual-Use Screening Survey**

PI (print name):\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ For DOHS use
only:

Institute: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ RD /
HPRD #: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

*A research project is considered dual-use in nature if the
methodologies, materials or results could be used for public harm. In an
effort to ensure that research performed at NIH is conducted and
published in a timely manner with due consideration given to experiments
potentially having dual-use concerns, the following questions must be
answered prior to the initiation of research. It should be noted that an
affirmative answer will not delay the progress of research, but
indicates that further review and consideration may be warranted as the
research advances.*

**This signed form must be included with each new RD and/or HPRD
application.**

+----------------------------------------------------+-----+-----+-----+
| **Screening Question**                             | *   | **N | *   |
|                                                    | *Ye | o** | *N/ |
|                                                    | s** |     | A** |
+----------------------------------------------------+-----+-----+-----+
| Will an intermediate or final product of your      |     |     |     |
| research make a vaccine less effective or          |     |     |     |
| ineffective?                                       |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| Will the intermediate or final product of your     |     |     |     |
| research confer resistance to antibiotics or       |     |     |     |
| antivirals?                                        |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 1.  Will your work enhance the virulence of a      |     |     |     |
|     pathogen or render a non-pathogen virulent?    |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| Will the results of your work increase the         |     |     |     |
| transmissibility of any pathogen?                  |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| Will your research result in the alteration of the |     |     |     |
| host range of the pathogen?                        |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| 6.  Will your research result in an intermediate   |     |     |     |
|     or final product that may prevent or interfere |     |     |     |
|     with the diagnosis of infection or disease?    |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| Does your research enable *weaponization*\* of an  |     |     |     |
| agent or toxin?                                    |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| Will synthetic biology^+^ techniques be used to    |     |     |     |
| construct a pathogenic organism, toxin or          |     |     |     |
| **potentially harmful** intermediate product?      |     |     |     |
+----------------------------------------------------+-----+-----+-----+
| Even if your planned research does not involve     |     |     |     |
| ***any*** of the aforementioned eight criteria,    |     |     |     |
| and recognizing that your work product or results  |     |     |     |
| of your research could conceivably be misused, is  |     |     |     |
| there the potential for your data/product to be    |     |     |     |
| ***readily*** utilized to cause public harm?       |     |     |     |
+----------------------------------------------------+-----+-----+-----+

\* In this context, weaponization refers to the enhanced dispersion,
deliverability, survivability or pathogenesis of a potentially harmful
agent or toxin.

^+^Synthetic biology includes, but is not limited to, techniques of
molecular biology, chemistry and genetics that would allow for the *de
novo* synthesis or reverse engineering of genes, gene products or entire
functional organisms.

  -----------------------------------------------------------------------
  For any question that was answered "yes", please provide sufficient
  information to allow for review of the indicated concern:

  -----------------------------------------------------------------------

**After considering the above answers, do you believe there is the
potential for your research data/product to be readily utilized to cause
public harm? □** Yes **□** No

PI Signature:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Reviewed by **□** DOHS **□** IBC:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Information regarding the dual-use dilemma in biological research may be
found at: <http://www.serceb.org/modules/serceb_cores/index.php?id=2>.