HEALTH RESEARCH ETHICS COMMITTEE 1 AND 2 PAYMENT INSTRUCTION: RESEARCH (INFORMATION SHOULD BE TYPED) Please submit this completed form and proof of payment (or internal requisition number) with your HREC application SECTION 1: DETAILS OF APPLICANT/PRINCIPAL INVESTIGATOR PROJECT ID NUMBER Title, First name, Surname: SU number: (HREC office use only) University DIVISION or DEPARTMENT: SECTION 2: TITLE OF STUDY Title of Research Project: SECTION 3: FUNDING SOURCE (Please check [X] the relevant funding source and indicate funder and project budget) NIH/US government funded research international grant funded research (e.g. Wellcome Trust) National funded research (e.g. NRF, MRC, CSIR, etc.) Crossley funded research (exempt from HREC review fees) Research funded solely from SU departmental budget (exempt from HREC review fees) Self funded research (exempt from HREC review fees) Non-sponsored student research for degree purposes at Stellenbosch University (exempt from HREC review fees) Funder: TOTAL PROJECT BUDGET: SECTION 4: SUBMISSION FOR HREC REVIEW (Please circle/highlight the appropriate HREC fee for either section A + B: International grant or C: National grant) HREC FEE Submission for HREC review A + B C New application R12,000 (research budget > R5million) R5,500 New application R8,250 (research budget R1million to R5million) New application R4,250 R2,850 (research budget R500,000 to R1million) New application R2,150 R1,450 (research budget R100,000 to R500,000) New application R1,000 R720 (research budget < R100,000) Extension / Roll-over study / Sub-study R1,000 R720 Annual re-certification / Progress report R1,000 - Protocol amendment: Major R1,000 R720 (changes to study aims/methods/procedures) Protocol amendment: Minor R720 - (small changes that do not affect study design) Informed consent amendment R720 R500 Additional investigator (per investigator) R500 - Administrative charge lost letters, copies of documents, and follow-ups R500 R500 –
HEALTH RESEARCH ETHICS COMMITTEE 1 AND 2 PAYMENT INSTRUCTION: RESEARCH (INFORMATION SHOULD BE TYPED) Please submit this completed form and proof of payment (or internal requisition number) with your HREC application SECTION 1: DETAILS OF APPLICANT/PRINCIPAL INVESTIGATOR Title, First name, Surname: SU number: PROJECT ID NUMBER (HREC office use only) University DIVISION or DEPARTMENT: SECTION 2: TITLE OF STUDY Title of Research Project: SECTION 3: FUNDING SOURCE (Please check [X] the relevant funding source and indicate funder and project budget) NIH/US government funded research international grant funded research (e.g. Wellcome Trust) National funded research (e.g. NRF, MRC, CSIR, etc.) Crossley funded research (exempt from HREC review fees) Research funded solely from SU departmental budget (exempt from HREC review fees) Self funded research (exempt from HREC review fees) Non-sponsored student research for degree purposes at Stellenbosch University (exempt from HREC review fees) Funder: TOTAL PROJECT BUDGET: SECTION 4: SUBMISSION FOR HREC REVIEW (Please circle/highlight the appropriate HREC fee for either section A + B: International grant or C: National grant) Submission for HREC review HREC FEE A + B C New application (research budget > R5million) R12,000 R5,500 New application (research budget R1million to R5million) R8,250 New application (research budget R500,000 to R1million) R4,250 R2,850 New application (research budget R100,000 to R500,000) R2,150 R1,450 New application (research budget < R100,000) R1,000 R720 Extension / Roll-over study / Sub-study R1,000 R720 Annual re-certification / Progress report R1,000 - Protocol amendment: Major (changes to study aims/methods/procedures) R1,000 R720 Protocol amendment: Minor (small changes that do not affect study design) R720 - Informed consent amendment R720 R500 Additional investigator (per investigator) R500 - Administrative charge – lost letters, copies of documents, and follow-ups R500 R500
20160310%20V1.10%20HREC%20PaymentInstruction_Health%20research.docx