PLEASE SUBMIT APPLICATION TO Clinical Research Budget Analyst (crba@seattlechildrens.org) Date Received by CRBA: SECTIONS 6-7 TO BE COMPLETED BY CRBA/OSR/CBO Section 6: Financial Compliance Approval Budget/FRA Finance/Budget Approved by: Approved by: Date CRBA M. Palmer Date CBM If a Center not identified Advance Activity Confirmation is providing resources (e.g. Change in Short Title: Yes No space, personnel, etc.) to this New Short Title (30 characters): proposal, identify and obtain CBM Approval: Advance Created: Yes No Advance Activity Lawson Number: Date Important: If an advance is created after signoff, please notify OSR. Section 7: Administrative Questions & Approvals Is Seattle Children’s (PI, faculty, and/or staff) primarily providing consulting services under this award? YES NO 2. Beyond a prior review for confidential information and/or a reasonable delay for IP protection, does the contract give the YES NO sponsor the right to restrict the publication of study results or other Children’s-generated data? Remarks OSR Administrative Institutional Approval Approved by: Approved by: Date James B. Hendricks, PhD Date Contract Negotiator OSR The project involves (check all that apply): Information Systems Adding software not currently installed on SCRI computers, or access to run Approved by: at another organization Acquisition of new servers, or mobile devices other than laptops Significant additions to data storage–either at SC or at another organization Use of PHI or confidential data as defined by the Seattle Children’s Security Policies Date IS Is the award subject to Unrelated Business Income Tax? YES NO Remarks ORF
PLEASE SUBMIT APPLICATION TO Clinical Research Budget Analyst (crba@seattlechildrens.org) Date Received by CRBA: SECTIONS 6-7 TO BE COMPLETED BY CRBA/OSR/CBO Section 6: Financial Compliance Approval Budget/FRA Finance/Budget Approved by: Approved by: CRBA M. Palmer Date CBM Date If a Center not identified is providing resources (e.g. space, personnel, etc.) to this proposal, identify and obtain CBM Approval: Advance Activity Confirmation Change in Short Title: Yes No New Short Title (30 characters): Advance Created: Yes No Advance Activity Lawson Number: Date Important: If an advance is created after signoff, please notify OSR. Section 7: Administrative Questions & Approvals OSR Is Seattle Children’s (PI, faculty, and/or staff) primarily providing consulting services under this award? YES NO 2. Beyond a prior review for confidential information and/or a reasonable delay for IP protection, does the contract give the sponsor the right to restrict the publication of study results or other Children’s-generated data? YES NO Remarks Administrative Institutional Approval Approved by: Approved by: Contract Negotiator Date OSR James B. Hendricks, PhD Date The project involves (check all that apply): Adding software not currently installed on SCRI computers, or access to run at another organization Acquisition of new servers, or mobile devices other than laptops Significant additions to data storage–either at SC or at another organization Use of PHI or confidential data as defined by the Seattle Children’s Security Policies Information Systems Approved by: IS Date ORF Is the award subject to Unrelated Business Income Tax? YES NO Remarks
osr-010-f03-contract-initiation-request-form-cirf-2017-06-20.docx