*Adjusted Form Due Date: The form due date will automatically get recalculated if the new form added is more than 4 months past its original form due date. This update was introduced for forms coming due after October 2021 release. The FormsNet Forms Grid will indicate if a form has an adjusted due date with an asterisk next to the adjusted due date.

Example:

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Below is a table summarizing the forms included in CPI and their respective due dates.

Critical Forms

As of September 2021, US centers will be required to complete 50% of these forms by the form due date during the current trimester and 98% of these forms by end of the trimester following the due date in order to meet CPI Standards.

Forms UPDATED Due Date (April 2021 FN Release)
Indication Form (2814) CRID Registration Date + 30 days
Pre-TED (2400) Infusion Date + 30 days
Disease Classification (2402) Infusion Date + 30 days
HCT Infusion Form (2006) Infusion Date + 45 days

Other Forms

As of September 2021, US centers will be required to complete 95% of these forms by end of the trimester following the due date in order to meet CPI Standards.

Forms UPDATED Due Date (April 2021 FN Release)
Eligibility (2500)
Patient Contact (2820)
Infusion Date + 30 days
Pre-CTED (4000) Infusion Date + 30 days
CT Product Form (4003)
CT Infusion Form (4006)
Infusion Date + 45 days
Gene Therapy Product (2003) Infusion Date + 45 days
Baseline (2000)
Infectious Disease Markers (2004)
HLA Typing (2005)
Pre-Infusion Disease / Infection (2010-2058)
Infusion Date + 60 days
100 Day Follow-up (2450, 2100, 4100)
100 Day Post-Infusion Disease / Infection Forms (2110-2158)
100 Day Chimerism Form (2451)
Infusion Date + 130 Days
6 Month Follow-up (2450, 2100, 4100)
6 Month Post-Infusion Disease / Infection Forms (2110-2158)
6 Month Chimerism Form (2451)
Infusion Date + 225 days
1 Year Follow up, 2 Year Follow-up
(2450, 2100, 4100)
1 Year Post-Infusion, 2 Year Post-Infusion Disease / Infection Forms (2110-2158)
1 Year, 2 Year Chimerism Form (2451)
Anniversary Date + 45 days
3+ Year Follow-up (2450, 2100, 4100)
3+ Year Post-Infusion Disease, Infection Forms (2110-2158)
Anniversary Date + 60 days
Secondary Neoplasm Form (3500)
Pregnancy Form (3501)
Event Date + 30 days
Death Form (2900) Death Date + 30 days
Donor Lymphocyte Infusion Form (2199) Date Reported + 30 days

Study Supplemental Forms

As of September 2021, US centers will be required to complete 100% of these forms by end of the trimester following the due date in order to meet CPI Standards.

Forms Visit UPDATED Due Date (July 2021 FN Release)
BMT CTN 1702 Enrollment Form (2532) n/a Enrollment Date + 30 days
BMT CTN 1702 Donor Testing Form (2533) n/a Evaluability Determination + 180 days
BMT CTN 1702 Monthly Update Form (2534) 1 Month Evaluability Determination + 30 days
2 Month Evaluability Determination + 60 days
3 Month Evaluability Determination + 90 days
4 Month Evaluability Determination + 120 days
5 Month Evaluability Determination + 150 days
6 Month Evaluability Determination + 210 days
BMT CTN 1702 Adverse Event Form (2535)
BMT CTN 1702 Off Study Form (2536)
BMT CTN 1702 Protocol Deviation / Violation Form (2537)
n/a Submission Date
Tepadina® Supplemental Data Collection Form (2540) 100 day Infusion Date + 130 days
6 month Infusion Date + 225 days
1 year, 2 year Anniversary Date + 45 days
3, 4, 5 year Anniversary Date + 60 days
Inotuzumab Ozogamicin (Besponsa™) Supplemental Data Collection Form (2541) n/a Infusion Date + 30 days
Mogamulizumab (Poteligeo) Supplemental Data Collection Form (2542) 100 day Infusion Date + 130 days
6 month Infusion Date + 225 days
1 year, 2 year Anniversary Date + 45 days
Gemtuzumab Ozogamicin (Mylotarg ™) Supplemental (2543) n/a Administration Date
Veno-occlusive Disease (VOD) /
Sinusoidal Obstruction Syndrome (SOS) Supplemental Data Collection Form (2553)
100 day Infusion Date + 130 days
6 month Infusion Date + 225 days
CMS Registration Form (2554) n/a Infusion Date + 30 days
CMS – MF Myelofibrosis Eligibility Form (2555) n/a Infusion Date + 30 days
Myelofibrosis Pre-HCT Supplemental Data (2556) n/a Infusion Date + 30 days
CMS-SCD Sickle Cell Disease Eligibility Form (2558) n/a Infusion Date + 30 days

The following forms are currently excluded from CPI:

Form numbers: 2008, 2800, and 2801
Form numbers: 5000 – 5002

Last modified: Jun 27, 2022