Protocol Registration System (Logo) Federal Sponsors' Logos: DHHS, NIH, FDA
  Account Application
OMB NO: 0910-0459
EXPIRATION DATE: 01/31/2011
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.
  1. Only data on trials approved by the appropriate regulatory authority may be submitted to ClinicalTrials.gov.
  2. Notice of recruiting status changes must be done immediately, and all submitted data must be reviewed, verified and updated at a minimum of every six months.
  3. The submitting organization is responsible for the completeness and accuracy of the data submitted to ClinicalTrials.gov.
  4. Trial data must be submitted in English.
  5. Multiple groups within a single entity (e.g., company, university, government agency) must share a single PRS organization account.
  6. Previous versions of trial 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 trial(s) to be registered.
    Type of Organization:
    Country:
    Organization Name:
    Organization Address:
    Organization Abbreviations and Acronyms:
    Parent Organizations,
if any:
    Official Representative:
    Phone:
    Email:
    Organization URL (optional):
    Funding Organization:
 
Administrator Information: The administrator is the person authorized by the sponsor to update the information in the Protocol Registration System (PRS) and will serve as the point of contact for the ClinicalTrials.gov staff.
    Administrator Name:
    Affiliation (if not the sponsor):
    Administrator Phone:
    Administrator Email:
 
Regulatory Information: The regulatory authority may 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 Protocol Registration System (PRS) may be sent to register@ClinicalTrials.gov.