NSLHD RESEARCH OFFICE PAYMENT FORM –

AMENDMENT TO APPROVED PROJECT – HREC &/OR RGO REVIEW

YOUR SUBMISSION IS NOT VALID UNLESS THIS FORM IS COMPLETED CORRECTLY –

Type in the GREY fields and choose from options in the grey drop-down lists

Date
Study Title
NSLHD Reference (RESP/xx/xxx or xxxx-xxxM)
Principal Investigator
Funding / sponsor type / Fully commercially sponsoredCollaborative group (>$50000 commercial support) Collaborative group (no commercial funding)Funded by Category 1 grant (eg NHMRC)Investigator initiated - no external fundingOther (please specify)
Payment type(you may only request an invoice if the study is externally funded eg. pharmaceutical company sponsor, or if you do not have an NSLHD cost centre eg. external/collaborative group) / NSLHD cost centreTax invoice for external payee
Submission type (tick all that apply):
HREC review
RGO review / Protocol amendment
Update to PISCF
IB update / Update to other study documents
INTERNAL - AUTHORISATION FOR TRANSFER OF PAYMENT
Account / Cost centre / Fund / Total fee (to be entered by researcher – consult the fee schedule on the Research Office website)
AUTHORISED BY:
Cost Centre Manager – Name: Signature:
Contact No: NSLHD Finance WILL NOT accept forms without the Cost Centre Manager’s signature
EXTERNAL – REQUEST FOR TAX INVOICE(THIS FORM IS NOT A TAX INVOICE)
(note that University of Sydney affiliates must not choose this option if they have a cost centre; investigators must use their NSLHD cost code unless fees are being paid by an external sponsor)
Name of Organisation/Person to be invoiced:
Total fee to be paid:(Consult the fee schedule on the Research Office website – please note that fees are due per amended IB or protocol, ie. an IB update and protocol amendment = $550 +$550)
Postal Address:
Contact Name:
Phone No: Email address: ***If you require an invoice showing amended documents with a particular naming convention, please list amended documents exactly as they should appear on the invoice (copy/paste from amendment form):

Approval letters are not issued until a correctly completed form is received.Please DON’T PRINT pages 2-3. Contact the Research Office if assistance is required: 02 9926 4590 |

TABLE OF FEES – HREC AND GOVERNANCE REVIEW

HREC SUBMISSION AND REVIEW FEES
Submission to the Full HREC / Commercially sponsored research project / $3300
Collaborative / Co-operative Group research project with commercial funding over $50000 / $3300
Investigator Initiated research project within NSLHD and/or the University of Sydney, including Student Projects / $150
Collaborative / Co-operative research project / $150
Investigator Initiated research projects external to the NSLHD and the University of Sydney / $300
Amendments to approved projects / Amendments to commercially sponsored research projects e.g. protocol, IB. If updated PISCF are submitted with either protocol or IB, no fee applies / $550 per amended document
Complex amendment to commercially sponsored study / $1665
Amendment to Collaborative / Co-operative Group research project with commercial funding over $50000
eg. protocol, IB. If updated PISCF are submitted with either protocol or IB, no fee applies / $550 per amendment document
Amendment to investigator initiated project within NSLHD and/or University of Sydney, including student projects / $100
Amendment to Collaborative / Co-operative research project / $100
Amendment to investigator initiated research projects external to the NSLHD and the University of Sydney / $150
External Entity Agreements for HREC to extend approval to Private Institution / $1000 PA
GOVERNANCE SUBMISSION AND REVIEW FEES
Site Specific Assessment (SSA) / Commercially sponsored research project / $3740
Collaborative / Co-operative research project with commercial funding over $50000 / $3740
Investigator Initiated research project within NSLHD and/or University of Sydney, including student projects / $150
Collaborative / Co-operative research project / $500
Investigator Initiated research projects external to the NSLHD and the University of Sydney / $300
Complex Amendment
Administration Fee where the NSLHD is not the Lead HREC / Commercially sponsored research project / $500
Collaborative / Co-operative research project with commercial funding over $50000 / $500
Amendment to Investigator Initiated research project within NSLHD and the University of Sydney including Student Projects / $100
Amendment to Collaborative / Co-operative research project / $100
Amendment to investigator initiated research projects external to the NSLHD and the University of Sydney / $150

TABLE OF FEES – HREC AND GOVERNANCE REVIEW FOR

LOW / NEGLIGIBLE RISK PROJECTS

HREC SUBMISSION AND REVIEW FEES
Low/Negligible Risk Projects / Commercially sponsored research project / $3300
Collaborative / Co-operative research project with commercial funding over $50000 / $3300
Investigator Initiated research project within NSLHD and/or the University of Sydney, including Student Projects / $100
Collaborative / Co-operative research project / $100
Investigator Initiated research projects external to the NSLHD and the University of Sydney / $200
LNR Amendments / Amendments to commercially sponsored projects / $550
Amendment to Collaborative / Co-operative Group research project with commercial funding over $50000 / $550
Amendment to Investigator Initiated research project within NSLHD and the University of Sydney including Student Projects / $75
Amendment to Collaborative / Co-operative research project / $75
Amendment to investigator initiated research projects external to the NSLHD and the University of Sydney / $100
GOVERNANCE SUBMISSION AND REVIEW FEES
Low/Negligible Risk SSA / Commercially sponsored research project / $1665
Collaborative / Co-operative research project with commercial funding over $50,000. / $1665
Investigator Initiated research project within NSLHD and the University of Sydney including Student Projects / $150
Collaborative / Co-operative research project / $150
Investigator Initiated research projects external to the NSLHD and the University of Sydney / $250
Complex LNR Amendment
Administration Fee where the NSLHD is not the Lead HREC / Amendments to commercially sponsored projects / $500
Amendment to Collaborative / Co-operative Group research project with commercial funding over $50000 / $500
Amendment to Investigator Initiated research project within NSLHD and the University of Sydney including Student Projects / $75
Amendment to Collaborative / Co-operative research project / $75
Amendment to investigator initiated research projects external to the NSLHD and the University of Sydney / $100
Fees are inclusive of GST

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