Form 1 IRB Transmittal

CTEP Support Contracts Forms and Surveys (NCI)

Attachment_A01_irbtrans

CTSU IRB/Regulatory Approval Transmittal Form (Attachment A1)

OMB: 0925-0753

Document [pdf]
Download: pdf | pdf
Attach_1a_CTSUTS
Attachment_A01_IRBTRANS

OMB#0925-xxxx
0925-0624
OMB#
ExpirationDate
Date:xx/xx/xxxx
12/31/2013
Expiration

Public reporting burden for this collection of information is estimated to average 2 minutes per response,
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Attachment_A1_IRBTRANS

CTSU Transmittal Sheet


OMB# 0925-xxxx
Expiration Date xx/xx/xxxx

SCT-0000000059

Date Sent:

/
mm

/
dd

yy

Total Pages Sent (______)
SEND TO: CTSU CENTRAL REGULATORY OFFICE
ATTN: Coalition of Cancer Cooperative Groups (CCCG)
Suite 1100
1818 Market Street
Philadelphia, PA 19103
FAX: 1-215-569-0206

[email protected]
Packet Type:

enrolled
next
three
days)
Urgent (patient(s)
(patient to to
bebe
enrolled
in in
thethe
next
three
days)

Normal

Attn: ________________________ 

Applicable NCI Institution Codes: ________________________________ 

Applicable Protocol Numbers: ___________________________________ 

Institutional Principal Investigator (if applicable):___________________


Protocol Contact at Site:

First Name

Last Name

Phone

e-mail

Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Final_January_2016
Authorized by CTSU for local reproduction


File Typeapplication/pdf
File Modified0000-00-00
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