ClinCard Study Set-up Request

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Instructions:

Complete this form to request that the Clinical Trials Office set up a clinical research study in the ClinCard system in order for research participants to be paid for milestone study visits or reimbursed for expenses via electronic debit card. To complete this form, you will need:

Basic Study Information
The finalized contract/budget information, including total study budget for reimbursement and stipend payment.
The Oracle Project number assigned to the project by Grant and Contract Accounting and your unit's UDO string.
Rutgers eIRB number
IRB approved consent form (to verify that the IRB has approved the payment amount and schedule)
A completed excel schedule of events for study payments:
- Download Excel template
Excel list of individuals authorized to make subject payments for this study and the list of approvers authorized by your school or unit for this study.
- Download Excel template

Please direct any questions you may have to clincard@rbhs.rutgers.edu.

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Today's Date

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M-D-Y

Submitter Name (Your Name)

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Submitter's Email

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Departmental Information

PI First Name

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PI Last Name

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PI Email

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School/Institute

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Other

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Department

Division

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