Standard Application Form For The Ethical Review Of Health-Related Research Studies, Which Are Not Clinical Trials Of Medicinal Products For Human Use As Defined In S.i. 190/2004 Page 23
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24Version 5.5
May 2011
Office Use:
-
REC Reference No:__________
J3 (a) Who or what legal entity is the sponsor of this research study?
Answer
J3 (b) What additional indemnity arrangements has the sponsor put in
place for this research study in case of harm being caused to a
research participant (if any)?
Answer
SECTION K
COST AND RESOURCE IMPLICATIONS AND FUNDING
SECTION K IS MANDATORY
IMPORTANT NOTE:
This application form permits the applicant to delete
individual questions within each section depending on their response to the
preceding questions. Please respond to each question carefully and refer to the
accompanying Guidance Manual for more in-depth advice prior to deleting any
question.
K1 (a)
Are there any cost / resource implications related to this
study?
Yes / No
K1 (b) If yes, please elaborate.
Answer
K2 (a) Is funding in place to conduct this study?
Yes / No
K2 (b) If no, has funding been sought to conduct this study?
Yes / No
K2 (c) Please state the source of funding (industry, grant or other)
and the amount of funding.
Answer
K2 (d) Is the study being funded by an external agency?
Yes / No
K2 (e) Is the external agency a ‘for profit’ organisation?
Yes / No
K2 (f) Do any conflicts of interest exist in relation to funding? Please
elaborate.
Answer
K2 (g) Please provide additional details in relation to management of
funds.
Answer
23 |
P a g e
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