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Hispanic Translation Center
RASCAL PT-TrakID
:
Brief title
:
Submitted by
:
Created
:
Modified
:
Principal Investigator
Name:
Telephone:
Pager:
E-mail:
Coordinator:
Part 1. To be completed by submitter.
Study
IRB number
CU account #
Sponsor type
-- Select --
Industry
NIH
Non-sponsored/Foundation
Department
HTC
document
Title
Date submitted
E-mail document(s)
Type of service
-- Select --
Translation
Modification
Review
# pages submitted
Fee for service
$
Working days
Estimated approval date
Services and Rates
Translation
Any sponsor:
$150 per page ($150 minimum)
Modification
Any sponsor:
$40 per page ($40 minimum)
Review and edit of translation done outside of HTC
Any sponsor:
$40 per page ($40 minimum)
Certification of Translation
None
Rush
None
I agree to pay the fee quoted by the HTC
Form is not yet complete. Do not yet forward information to Clinical Trials Office.
Form is complete. Forward information to Clinical Trials Office.
Part 2. To be completed by the HTC.
Date received
# pages received
Date initiated
Translated by
-- Select --
Magaly Garcia
Angela Barret
Cristina Bertrand
Carmen Ferreiro
Clemencia Gil
Sergio Graciano
Leticia Molinero
Other
Approved by
-- Select --
Magaly Garcia
Other
Date approved
Variance (days)
Fee for service $
Comments
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