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FORM APPROVED OMB Approval No. 09170009 Expiration Date: 6/30/2016 Estimated response time below. Manual Exhibit 31A Page 1 of 20INDIAN HEALTH SERVICE Application for Medical Staff Appointment and/or
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01
To fill out the Form FDA 1572 (Investigator Statement) Department of, follow these steps:
02
Start by entering the name and address of the investigator on the top of the form.
03
Fill out the Investigational New Drug (IND) Number, if applicable.
04
Provide the name of the study or protocol title.
05
Indicate the name and address of the sponsor or sponsor-investigator.
06
Specify the name, phase, and protocol number of the study.
07
Enter the name and address of the medical institution where the study will be conducted.
08
Fill out the Certification section and date it accordingly.
09
Make sure the investigator signs and dates the form.
10
After completing the form, submit it according to the instructions provided by the FDA.
11
Keep a copy of the filled-out form for your records.

Who needs form fda 1572department of?

01
The Form FDA 1572 (Investigator Statement) Department of is required for investigators who are involved in clinical trials or studies conducted on investigational drugs or biologics regulated by the U.S. Food and Drug Administration (FDA).
02
This form is necessary to document the commitment and agreement of the investigator to adhere to the protocol, conduct the study ethically, and comply with the FDA regulations.
03
Both individual investigators and institutions conducting clinical trials may need to fill out this form.
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Form FDA 1572 is the Statement of Investigator form used by the U.S. Food and Drug Administration (FDA) to collect information about clinical investigators conducting research on investigational drugs or medical devices.
Clinical investigators conducting research on investigational drugs or medical devices are required to file Form FDA 1572.
Form FDA 1572 should be filled out by providing accurate and complete information about the clinical investigator, research site, study protocol, and other required details.
The purpose of Form FDA 1572 is to document the agreement between the clinical investigator and the FDA to comply with regulations governing the conduct of clinical trials.
Information such as the name and qualifications of the clinical investigator, the name and address of the research site, the protocol number of the study, and the signature of the investigator must be reported on Form FDA 1572.
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