Form 7 Supply

CTEP Branch Support Contracts Forms and Surveys (NCI)

Attachment_A07_supply_06152018

CTSU Supply Request Form (Attachment A7)

OMB: 0925-0753

Document [pdf]
Download: pdf | pdf
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
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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.

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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


File Typeapplication/pdf
File TitleCTSU Supply Request Form
SubjectCTSU Supply Request Form
Authoryoung_l
File Modified2018-08-17
File Created2018-08-09

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