Forms

• Contract Certification Form
• IRB Information
• MTA Questionnaire
  • Incoming Materials
  • Outgoing Materials
• UBMTA Implementing Letter
  • Outgoing material updated 4/1/14
  • Incoming material updated 4/1/14
• Sponsor Study Budget Template - Sample
• Departmental/Internal Budget Template - Sample
• WBS Element Advance Account Request
• Service Agreement – payable (processing through Finance and Operations)
• Additional Terms and Conditions to Service Agreement
• DUA Intake

Billing Compliance

• UT Clinical Trial Billing Procedure
• Medicare Coverage Analysis - Determination of Qualifying Trial
• Routine Cost Under a Medicare Qualifying Trial
• Billing Grid A (fillable)
• Billing Grid B (fillable)

UCH – University Clinical Health

• Request to Conduct Research UCH
• UCH Study Specific Agreement
• Master Clinical Research Study Site Agreement

ROH - Regional One Health

• Master Research Agreement
• Application of Approval (Form 1)
• Request for Research (Form A)