U.S. National Institutes of Health
Last Updated: 10/15/09

CTEP Forms, Templates and Documents

Click on download to download the desired document.

Investigator Registration (1572) Form

Form Title Adobe Acrobat (.pdf) MS Word (.doc) WordPerfect (.wpd)
FDA Form 1572 for Investigator Registration [Download FDA 1572 Form]    
Supplemental Form for Investigator Registration [Download Supplemental Form]    
Financial Disclosure Form for Investigator Registration [Download Financial Disclosure Form]    

Protocol Development and Assembly

Form Title Adobe Acrobat (.pdf) MS Word (.doc) WordPerfect (.wpd) Excel (.xls)
Letter of Intent (LOI) Submission Form v2.0   [Download LOI Form]    
Career Development LOI Instructions   [Download LOI Instructions]    
Cost Estimate Worksheet       [Download LOI Form]
Concept Submission Form   [Download Concept Submission Form]    
Protocol Templates:        
AE Templates (Updated March 9, 2005):        
     AE Template Phase I Single Agent v1.1   [Download Phase I Single Agent Form]    
     AE Template Phase I Combination v1.1   [Download Phase I Combination Form]    
     AE Template Phase II Single Agent v1.1   [Download Phase II Single Agent Form]    
     AE Template Phase II Combination v1.1   [Download Phase II Combination Form]    
NCI Informed Consent Templates   [Download NCIIC Form]    
CTCAE v3.0 and Lay Term Mapping Document   [Download NCIIC Form]   [Download NCIIC Form]
Protocol Submission Worksheet v4.4 [Download Form] [Download Form]    
CTC Generic Data Collection Form [Download Form] [Download Form]    
Protocol Status Update (Updated March 1, 2004)   [Download Protocol Status Update Form]    
Amendment Request Submission Checklist   [Download Amendment Request Submission Checklist]    
Correlative Science Guidelines   [Download Form]    

Requisition of Agents

Form Title Adobe Acrobat (.pdf) MS Word (.doc) WordPerfect (.wpd)
Clinical Drug Request (NIH - 986) Form [Download Clinical Drug Request Form]    
NCI Investigational Drug Accountability Record Form [Download NCI Investigational Drug Accountability Record form]    
NCI Transfer Investigational Agent Form [Download NCI Transfer Investigational Agent Form]    
NCI Return Investigational Agent Form [Download NCI Return Investigational Agent Form]    

Reporting Forms

Form Title Adobe Acrobat (.pdf) MS Word (.doc) WordPerfect (.wpd)
AdEERS Single Agent Template [Download FDA Form 3500]    
AdEERS Multiple Agent Template [Download FDA Form 3500]    
Secondary AML/MDS Form [Download Secondary AML/MDS]    

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