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ABN 77 054 038 872
Research Office Credit Card Payment
Instructions
1. Fees are payable in FULL at the time of submitting documentation to the Research Office.
2. Only one Research Project payment may be submitted per Fee Payment Form.
3. Contact the Research Office (02 8382 4960) for a 'Fee Payment Reference number' (FPR#), required to complete this form.

* MANDATORY FIELDS
Research Office Fee Payment Reference (FPR#)*
(Mandatory for processing of payment contact the Research Office for FPR# to be issued - phone: 02 8382 4960)

Study Investigator Name*
Full Project Title*
SVH File Reference Number
(eg 10/000) applicable to amendments only
Company*
ABN*
Address*
Contact Name*
Email*
Phone Number*

St Vincent's HREC and Governance Fee Structure
Fees are payable in FULL at the time of the submission of a project or amendment. Fees are mandated by NSW Health
Type of Application
HREC Fees
Research Governance Fees
External Entity Requesting HREC Review Only
Amendments to approved Research Project
Fees are applied to each version change to Investigator's Brochures (or equivalent) and protocol documents (or equivalent). Note amendment fees do not apply to minor administrative changes.
Sub-studies / Substantial Amendments
Sub-studies and substantial amendments will be reviewed and the fee determined on a case by case basis. The HREC Executive may request that the sub-study be submitted as a full application and charge the full fee.

Your Privacy: St Vincent's Health Australia (SVHA) respects your privacy and complies with the National Privacy Principles. SVHA only collects that information needed to provide and communicate services to you. I authorise St Vincent's Hospital to deduct this amount from my credit card on receipt of this form.
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