Form 7 Supply

Attachment_A7_supply

OMB# 0925-0753
Expiration Date 07/31/2021

Public reporting burden for this collection of information is estimated to average 10 minutes per
response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. An agency
may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 208927974, ATTN: PRA (0925-0753). Do not return the completed form to this address.

Filling out PDF Forms
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This form allows you to enter data directly onto the screen. After completing the form, you are
able to print the document so that you can fax/mail the document.
To fill out a form:

1. Select the hand tool.
2. Position the pointer inside a field, and click to type text.
3. After entering text or selecting a check box, do one of the following:
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deselect the current form field.

4. Once completed, print the form.

OMB# 0925-0753
Expiration Date 07/31/2021

Attachment_A7_supply

CTSU Supply Request Form:
To request supplies from CTSU, please complete the information below and upload the form to the Regulatory
Submission Portal. Select the Membership/Supplies document type at www.ctsu.org and select the
membership/supply document type. Following review and approval of this application, the requested item will be
mailed to the address you provide below. Please allow 7-10 business days for processing and mailing of supply
requests.
Protocol Number (s)
Item Requested
Number Requested

Contact Name
Institution CTEP ID
Office
Street 1
Street 2
City
State
Zip
Phone
E-mail
Shipping preference Select one:
Fed Ex
Provide account number:
☐
U.S. Mail

☐

PLEASE NOTE: When a Fed Ex number is provided shipments will be sent standard overnight unless the submitter notes on
the form that two-day or priority shipping is needed. Fed Ex shipping cost will be billed to the account number provided.

CTSU Internal Reminders:
Verify the site registration status is active
Set Packet to complete and add FedEx tracking # to the comments if applicable
Revised_July_2018
Authorized by CTSU for local reproduction