CIRB Application Form Instruction Sheet This Page is for information only and need not be submitted CIRB Submission Deadline The submission deadline for the month’s Full Board Review is the first working day of that same month* at 12:00 noon. All relevant sections of the application form must be filled out completely, including signatures from your Head of Department and Institution Representative. Kindly note only complete submission will be reviewed. Thus it is strongly recommended that the applications be submitted at least 1 week before the deadline in order for the CIRB Secretariat to check for any missing documents. Incomplete submission will not be reviewed. Complete applications received after the deadline may only be reviewed in the following month’s Full Board Review. This is also applicable for any Amendments that may require Full Board Review (Always download the latest version of http://research.singhealth.com.sg/pages/centralisedinstitutionalreviewboard.aspx) the forms via CIRB Review Fees For studies which are initiated by SingHealth, there is no charge for the ethics review of their initial application and any subsequent amendments to the study protocol. For studies which are initiated by industry or commercial entities, the following review fees will apply: Initial IRB Application review - S$1000 + prevailing GST rate (i.e. S$1070) Subsequent Amendments - S$200 + prevailing GST rate (i.e. S$214) Payment is to be made by cheque. Please make the cheque payable to “Singapore Health Services Pte Ltd” and submit the cheque together with your applications. Kindly attach the following information with the cheque: Full protocol title PI’s name, department and institution Sponsor’s contact person (name and mailing address for receipt) Important: The CIRB will be unable to release the Approval Letters if payment has not been received. Submission Requirement 1 signed original and 10 copies (Kindly note there is the requirement for the signature of the relevant Institution Representative, please ensure you have fulfilled this requirement before sending in your application) Postal Address: CIRB Tel: Fax: Email: SingHealth Centralised Institutional Review Board 168 Jalan Bukit Merah #06-08 Tower 3 Connection One Singapore 150168 6323-7515 6236-6053 irb@singhealth.com.sg CIRB Application Form Instruction Sheet, Version 29, 4 Jul 2014 Page 1 of 2 The Six Review Boards of CIRB With effect from 2 May 2014, the Specialities in the Six Review Boards are as follows:- A B C D E F CIRB A CIRB B CIRB C Ophthalmology Psychiatry Neurology/Neurosurgery (Including sleep studies) Geriatric Medicine Nursing Health Service Research Oncology Cardiovascular Science Pharmacology Emergency Medicine Endocrinology Diagnostic Imaging Respiratory Medicine CIRB D CIRB E CIRB F Obs/Gynaecology Anaesthesia (including acupuncture) Surgery ENT Dentistry Gastroenterology Renal Medicine Rheumatology/Immunology Dermatology Paediatric Medicine Family Medicine Genetics Palliative Medicine Haematology (including haematological malignancies) Chair Secretariat Chair Secretariat Chair Secretariat Chair Secretariat Chair Secretariat Chair Secretariat Dr Khoo Chong Yew Chia Joo Yi A/Prof Lim Soon Thye Elaine Tan Hwee Kee Dr Jagadesan Raghuram Leow Boon Hwi Dr Steve Yang Phyllis Tham Jia Hui Dr Agnes Ng Stephanie Chung Wai Mei Dr Aloysius Ho Elaine Tan Hwee Kee Pathology Sports & Rehab Medicine Allied Health Infectious Disease 6377 8401 chia.joo.yi@singhealth.com.sg 6377 8403 elaine.tan.h.k@singhealth.com.sg 6377 8405 leow.boon.hwi@singhealth.com.sg 6377 8407 phyllis.tham.j.h@singhealth.com.sg 6377 8409 stephanie.chung.w.m@singhealth.com.sg 6377 8403 elaine.tan.h.k@singhealth.com.sg List of Institution Representatives Institution Bright Vision Hospital Changi General Hospital HCA Hospice Care Investigational Medicine Unit KK Women’s & Children’s Hospital National Cancer Centre Name Dr Lee Kheng Hock Dr Tan Thean Yen Dr R.Akhileswaran Dr Darren Lim A/Prof Jerry Chan Kok Yen Dr Vijay Kumar Sethi Prof Wong Tien Yin Designation Medical Director Head, Research CEO and Medical Director Director, Investigational Medicine Unit Director, KK Research Centre Senior Consultant, Dept of Radiation Oncology Head, Clinical Research Deputy Director, National Heart Research Institute Singapore Head, Clinical Trials Research Unit Chairman, Division of Research Institute Director, Singapore Eye Research Institute Group Director, Research National Dental Centre National Heart Centre Dr Goh Bee Tin A/Prof Tan Ru San National Neuroscience Institute Singapore General Hospital Singapore National Eye Centre / Singapore Eye Research Institute Singapore Health Services (SingHealth) SingHealth Polyclinics A/Prof Louis Tan Chew Seng A/Prof Lee Lai Heng Prof Aung Tin Dr Tan Ngiap Chuan Director, Research CIRB Application Form Instruction Sheet, Version 29, 4 Jul 2014 Page 2 of 2