NSLHD RESEARCH OFFICE PAYMENT FORM – NEW APPLICATION/SUBMISSION
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
Principal Investigator
Funding type
Fully commercially sponsored
Payment type (you may only request an invoice if the study is
NSLHD cost centre
externally funded eg. pharmaceutical company sponsor, or if you
do not have an NSLHD cost centre eg. external/collaborative
group)
Submission type (tick all that apply):
LNR Ethics
LNR SSA
NEAF Ethics
‘Full’ SSA
External Entity Agreement
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 (refer to fee schedule):
Postal Address:
Contact Name:
Phone No:
Email address:
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 | NSLHD-research@health.nsw.gov.au
Document1 Sep 2014
OFFICE USE: NSLHD Ref
Checked by:
Amount due: Ethics$
GOV$
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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 commercially sponsored research projects e.g. protocol, IB. If updated
PISCF are submitted with either protocol or IB, no fee applies
Complex amendment to commercially sponsored study
Amendments to
approved projects
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 amended
document
$1665
$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
Commercially sponsored research project
Collaborative / Co-operative research project with commercial funding over $50000
Complex Amendment
Administration Fee
Amendment to Investigator Initiated research project within NSLHD and the University of
where the NSLHD is not
Sydney including Student Projects
the Lead HREC
$500
$500
$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
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TABLE OF FEES – HREC AND GOVERNANCE REVIEW FOR
LOW / NEGLIGIBLE RISK PROJECTS
HREC SUBMISSION AND REVIEW FEES
Low/Negligible Risk
Projects
LNR Amendments
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
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
Complex LNR
Amendment
Administration Fee
where the NSLHD is
not the Lead HREC
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
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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