Apply for a PRS Individual Account

OMB No: 0925-0586 Expiration Date: 08/31/2015 Burden Statement
Each entity submitting data to ClinicalTrials.gov must adhere to the following terms and conditions, which are intended to ensure the accuracy, currency, and validity of the data:
  • Only data for studies that are in conformance with applicable human subjects or ethics review regulations (or equivalent) and applicable regulations of the national (or regional) health authority (or equivalent) may be submitted.
  • Notice of changes in recruitment status must be provided as soon as possible, but no later than 30 days after such changes. All other submitted data must be reviewed, verified, and updated as necessary and no less than every 12 months.
  • The submitting organization, or individual designated as the Responsible Party, is responsible for the completeness and accuracy of the data submitted to ClinicalTrials.gov.
  • Study data must be submitted in English.
  • Multiple groups within a single entity (e.g., company, university, government agency) must share a single Protocol Registration and Results System (PRS) organization account.
  • Previous versions of study data will be available to the public, although the default view will be the most recent version.
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Sponsor Information: The sponsoring organization is the entity with primary responsibility for initiating and conducting the study to be registered.
* Registering IND/IDE Trials?
* Type of Organization:
* Country:
* Organization Name:
* Organization Address:
Organization Abbreviations and Acronyms:
Parent Organizations,
if any:
* Official Representative:
* Phone:
Please enter a valid phone number, including area code.
* Email:
Organization URL (optional):
Funding Organization:
 
Investigator Information
* Investigator Name:
Affiliation (if not the sponsor):
* Investigator Phone:
Please enter a valid phone number, including area code.
* Investigator Email:
 
Regulatory Information: The regulatory authority can be a national or international health authority, an institutional review board, or an ethics committee.
* Regulatory Authority:
* Regulatory Authority Address:

To the best of my knowledge, the above information is true and correct.
Questions about this form and the PRS may be sent to register@ClinicalTrials.gov.

* Required
 
This page last reviewed in December 2014