Form BIR-1 "Qualified Research Institution Request for Approval" - New Jersey

What Is Form BIR-1?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2019;
  • The latest edition provided by the New Jersey Department of Health;
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  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form BIR-1 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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New Jersey Commission on Brain Injury Research
ACROBAT READER
QUALIFIED RESEARCH INSTITUTION
REQUIRED
New Jersey Commission on Brain Injury Research
FOR THIS FORM
REQUEST FOR APPROVAL
QUALIFIED RESEARCH INSTITUTION
New Jersey Commission on Brain Injury Research
REQUEST FOR APPROVAL
QUALIFIED RESEARCH INSTITUTION
The New Jersey Commission on Brain Injury Research requires that the organization or institution of a grant applicant
REQUEST FOR APPROVAL
be approved as a qualified research institution prior to the submission of a grant application.
The New Jersey Commission on Brain Injury Research requires that the organization or institution of a grant applicant
be approved as a qualified research institution prior to the submission of a grant application.
If your organization or institution appears below, you do not need to submit this document. Those organizations or
The New Jersey Commission on Brain Injury Research requires that the organization or institution of a grant applicant
institutions that have not been approved, and are not listed below, must apply.
be approved as a qualified research institution prior to the submission of a grant application.
If your organization or institution appears below, you do not need to submit this document. Those organizations or
institutions that have not been approved, and are not listed below, must apply.
Qualified Institutions
If your organization or institution appears below, you do not need to submit this document. Those organizations or
Rutgers, The State University of New Jersey
University of Medicine and Dentistry of New Jersey
(now
institutions that have not been approved, and are not listed below, must apply.
Qualified Institutions
Rutgers Univ.)
Kessler Medical Rehabilitation Center
9/16/06
Rutgers, The State University of New Jersey
University of Medicine and Dentistry of New Jersey
(now
Qualified Institutions
Kessler Foundation
9/16/06
Coriell Institute for Medical Research
9/16/06
Rutgers Univ.)
Kessler Medical Rehabilitation Center
9/16/06
Rutgers, The State University of New Jersey
University of Medicine and Dentistry of New Jersey
(now
New Jersey Institute of Technology
9/16/06
Kessler Foundation
9/16/06
Hackensack University Medical Center
9/16/06
Rutgers Univ.)
Coriell Institute for Medical Research
9/16/06
Kessler Medical Rehabilitation Center
9/16/06
Morristown Medical Hospital and Medical Center
11/10/09
New Jersey Institute of Technology
9/16/06
Stevens Institute for Technology
9/16/06
Kessler Foundation
9/16/06
Hackensack University Medical Center
9/16/06
Coriell Institute for Medical Research
9/16/06
(now part of Atlantic Health Systems Hospital Corporation)
Morristown Medical Hospital and Medical Center
11/10/09
Cooper University Hospital/Health System
New Jersey Institute of Technology
12/7/09
9/16/06
Stevens Institute for Technology
9/16/06
International Brain Research Foundation
12/7/09
Hackensack University Medical Center
9/16/06
(now part of Atlantic Health Systems Hospital Corporation)
Morristown Medical Hospital and Medical Center
11/10/09
Princeton University
12/7/09
Englewood Hospital Research
12/7/09
Cooper University Hospital/Health System
12/7/09
Stevens Institute for Technology
9/16/06
International Brain Research Foundation
12/7/09
(now part of Atlantic Health Systems Hospital Corporation)
Rowan University
12/13/11
CentraState Medical Center
3/15/11
Princeton University
12/7/09
Cooper University Hospital/Health System
12/7/09
Englewood Hospital Research
12/7/09
International Brain Research Foundation
12/7/09
Edge Therapeutics, Inc.
12/14/10
Saint Barnabas Medical Center
10/11/11
Rowan University
12/13/11
Princeton University
12/7/09
CentraState Medical Center
3/15/11
Englewood Hospital Research
12/7/09
Atlantic Health Systems Hospital Corporation
VA NJ Health Care System and Veterans Biomedical
12/7/09
Edge Therapeutics, Inc.
12/14/10
Saint Barnabas Medical Center
10/11/11
Rowan University
12/13/11
CentraState Medical Center
3/15/11
Research Institute
(Atlantic Health Care System Neuro. Institute)
Atlantic Health Systems Hospital Corporation
12/7/09
VA NJ Health Care System and Veterans Biomedical
Edge Therapeutics, Inc.
12/14/10
Saint Barnabas Medical Center
10/11/11
The Center for Neurological and Neurodevelopment
JFK NJ Neuroscience Institute, JFK Health System and
Research Institute
(Atlantic Health Care System Neuro. Institute)
Atlantic Health Systems Hospital Corporation
12/7/09
VA NJ Health Care System and Veterans Biomedical
Health II, Inc., The Center for Neurological and
Seton Hall University School Health Medical Science
12/07/09
The Center for Neurological and Neurodevelopment
JFK NJ Neuroscience Institute, JFK Health System and
Research Institute
(Atlantic Health Care System Neuro. Institute)
Neurodevelopment Health LLC, Clinical Research
Montclair State University
9/15/15
Health II, Inc., The Center for Neurological and
Seton Hall University School Health Medical Science
12/07/09
The Center for Neurological and Neurodevelopment
JFK NJ Neuroscience Institute, JFK Health System and
Center of NJ, and NeurAbilities
10/11/11
The College of New Jersey
9/15/15
Neurodevelopment Health LLC, Clinical Research
Montclair State University
9/15/15
Health II, Inc., The Center for Neurological and
Seton Hall University School Health Medical Science
12/07/09
St. Joseph’s University Medical Center
9/18/18
Visikol, Inc.
9/20/16
Center of NJ, and NeurAbilities
10/11/11
The College of New Jersey
9/15/15
Neurodevelopment Health LLC, Clinical Research
Montclair State University
9/15/15
William Paterson University of New Jersey
7/24/2019
St. Joseph’s University Medical Center
9/18/18
Center of NJ, and NeurAbilities
10/11/11
Visikol, Inc.
9/20/16
The College of New Jersey
9/15/15
Bright Cloud International Corp.
The completed form can be sent electronically to
6/16/20
NJCBIR@doh.nj.gov
or by mail to The New Jersey Commission
William Paterson University of New Jersey
7/24/2019
St. Joseph’s University Medical Center
9/18/18
Visikol, Inc.
9/20/16
on Brain Injury Research, 369 South Warren St., P.O. Box 360, Trenton, New Jersey 0862 5-0360. If you have
William Paterson University of New Jersey
7/24/2019
The completed form can be sent electronically to
NJCBIR@doh.nj.gov
or by mail to The New Jersey Commission
questions related to the completion of this form, please call the Commission office at 609-633-6465.
on Brain Injury Research, 369 South Warren St., P.O. Box 360, Trenton, New Jersey 0862 5-0360. If you have
The completed form can be sent electronically to
NJCBIR@doh.nj.gov
or by mail to The New Jersey Commission
questions related to the completion of this form, please call the Commission office at 609-633-6465.
on Brain Injury Research, 369 South Warren St., P.O. Box 360, Trenton, New Jersey 0862 5-0360. If you have
Name of Institution/Organization:
questions related to the completion of this form, please call the Commission office at 609-633-6465.
Name of Institution/Organization:
1. Is this Institution/Organization capable of receiving and administering federal and state grants?
Name of Institution/Organization:
1. Is this Institution/Organization capable of receiving and administering federal and state grants?
Yes
No
1. Is this Institution/Organization capable of receiving and administering federal and state grants?
Yes
No
2. Does this institution/organization have a Grant Administration Office (or equivalent) that is responsible
for overseeing grant programs?
Yes
No
2. Does this institution/organization have a Grant Administration Office (or equivalent) that is responsible
for overseeing grant programs?
Yes
No
2. Does this institution/organization have a Grant Administration Office (or equivalent) that is responsible
for overseeing grant programs?
Yes
No
IF YES, please list the grant administrator’s name, address, and phone number:
Yes
No
IF YES, please list the grant administrator’s name, address, and phone number:
Administrator’s Name:
IF YES, please list the grant administrator’s name, address, and phone number:
Administrator’s Name:
Address:
Room:
first / middle / last
Administrator’s Name:
Address:
Room:
City:
State:
Zip:
Address:
Room:
City:
State:
Zip:
Phone:
Email:
City:
State:
Zip:
Phone:
Email:
IF NO, please explain what type of fiscal oversight structure your institution or organization has in place:
Phone:
Email:
IF NO, please explain what type of fiscal oversight structure your institution or organization has in place:
IF NO, please explain what type of fiscal oversight structure your institution or organization has in place:
BIR-1
SEP 18
Page 1 of 2 Pages.
BIR-1
Page 1 of 2
BIR-1
SEP 18
Page 1 of 2 Pages.
AUGUST 20
BIR-1
SEP 18
Page 1 of 2 Pages.
New Jersey Commission on Brain Injury Research
ACROBAT READER
QUALIFIED RESEARCH INSTITUTION
REQUIRED
New Jersey Commission on Brain Injury Research
FOR THIS FORM
REQUEST FOR APPROVAL
QUALIFIED RESEARCH INSTITUTION
New Jersey Commission on Brain Injury Research
REQUEST FOR APPROVAL
QUALIFIED RESEARCH INSTITUTION
The New Jersey Commission on Brain Injury Research requires that the organization or institution of a grant applicant
REQUEST FOR APPROVAL
be approved as a qualified research institution prior to the submission of a grant application.
The New Jersey Commission on Brain Injury Research requires that the organization or institution of a grant applicant
be approved as a qualified research institution prior to the submission of a grant application.
If your organization or institution appears below, you do not need to submit this document. Those organizations or
The New Jersey Commission on Brain Injury Research requires that the organization or institution of a grant applicant
institutions that have not been approved, and are not listed below, must apply.
be approved as a qualified research institution prior to the submission of a grant application.
If your organization or institution appears below, you do not need to submit this document. Those organizations or
institutions that have not been approved, and are not listed below, must apply.
Qualified Institutions
If your organization or institution appears below, you do not need to submit this document. Those organizations or
Rutgers, The State University of New Jersey
University of Medicine and Dentistry of New Jersey
(now
institutions that have not been approved, and are not listed below, must apply.
Qualified Institutions
Rutgers Univ.)
Kessler Medical Rehabilitation Center
9/16/06
Rutgers, The State University of New Jersey
University of Medicine and Dentistry of New Jersey
(now
Qualified Institutions
Kessler Foundation
9/16/06
Coriell Institute for Medical Research
9/16/06
Rutgers Univ.)
Kessler Medical Rehabilitation Center
9/16/06
Rutgers, The State University of New Jersey
University of Medicine and Dentistry of New Jersey
(now
New Jersey Institute of Technology
9/16/06
Kessler Foundation
9/16/06
Hackensack University Medical Center
9/16/06
Rutgers Univ.)
Coriell Institute for Medical Research
9/16/06
Kessler Medical Rehabilitation Center
9/16/06
Morristown Medical Hospital and Medical Center
11/10/09
New Jersey Institute of Technology
9/16/06
Stevens Institute for Technology
9/16/06
Kessler Foundation
9/16/06
Hackensack University Medical Center
9/16/06
Coriell Institute for Medical Research
9/16/06
(now part of Atlantic Health Systems Hospital Corporation)
Morristown Medical Hospital and Medical Center
11/10/09
Cooper University Hospital/Health System
New Jersey Institute of Technology
12/7/09
9/16/06
Stevens Institute for Technology
9/16/06
International Brain Research Foundation
12/7/09
Hackensack University Medical Center
9/16/06
(now part of Atlantic Health Systems Hospital Corporation)
Morristown Medical Hospital and Medical Center
11/10/09
Princeton University
12/7/09
Englewood Hospital Research
12/7/09
Cooper University Hospital/Health System
12/7/09
Stevens Institute for Technology
9/16/06
International Brain Research Foundation
12/7/09
(now part of Atlantic Health Systems Hospital Corporation)
Rowan University
12/13/11
CentraState Medical Center
3/15/11
Princeton University
12/7/09
Cooper University Hospital/Health System
12/7/09
Englewood Hospital Research
12/7/09
International Brain Research Foundation
12/7/09
Edge Therapeutics, Inc.
12/14/10
Saint Barnabas Medical Center
10/11/11
Rowan University
12/13/11
Princeton University
12/7/09
CentraState Medical Center
3/15/11
Englewood Hospital Research
12/7/09
Atlantic Health Systems Hospital Corporation
VA NJ Health Care System and Veterans Biomedical
12/7/09
Edge Therapeutics, Inc.
12/14/10
Saint Barnabas Medical Center
10/11/11
Rowan University
12/13/11
CentraState Medical Center
3/15/11
Research Institute
(Atlantic Health Care System Neuro. Institute)
Atlantic Health Systems Hospital Corporation
12/7/09
VA NJ Health Care System and Veterans Biomedical
Edge Therapeutics, Inc.
12/14/10
Saint Barnabas Medical Center
10/11/11
The Center for Neurological and Neurodevelopment
JFK NJ Neuroscience Institute, JFK Health System and
Research Institute
(Atlantic Health Care System Neuro. Institute)
Atlantic Health Systems Hospital Corporation
12/7/09
VA NJ Health Care System and Veterans Biomedical
Health II, Inc., The Center for Neurological and
Seton Hall University School Health Medical Science
12/07/09
The Center for Neurological and Neurodevelopment
JFK NJ Neuroscience Institute, JFK Health System and
Research Institute
(Atlantic Health Care System Neuro. Institute)
Neurodevelopment Health LLC, Clinical Research
Montclair State University
9/15/15
Health II, Inc., The Center for Neurological and
Seton Hall University School Health Medical Science
12/07/09
The Center for Neurological and Neurodevelopment
JFK NJ Neuroscience Institute, JFK Health System and
Center of NJ, and NeurAbilities
10/11/11
The College of New Jersey
9/15/15
Neurodevelopment Health LLC, Clinical Research
Montclair State University
9/15/15
Health II, Inc., The Center for Neurological and
Seton Hall University School Health Medical Science
12/07/09
St. Joseph’s University Medical Center
9/18/18
Visikol, Inc.
9/20/16
Center of NJ, and NeurAbilities
10/11/11
The College of New Jersey
9/15/15
Neurodevelopment Health LLC, Clinical Research
Montclair State University
9/15/15
William Paterson University of New Jersey
7/24/2019
St. Joseph’s University Medical Center
9/18/18
Center of NJ, and NeurAbilities
10/11/11
Visikol, Inc.
9/20/16
The College of New Jersey
9/15/15
Bright Cloud International Corp.
The completed form can be sent electronically to
6/16/20
NJCBIR@doh.nj.gov
or by mail to The New Jersey Commission
William Paterson University of New Jersey
7/24/2019
St. Joseph’s University Medical Center
9/18/18
Visikol, Inc.
9/20/16
on Brain Injury Research, 369 South Warren St., P.O. Box 360, Trenton, New Jersey 0862 5-0360. If you have
William Paterson University of New Jersey
7/24/2019
The completed form can be sent electronically to
NJCBIR@doh.nj.gov
or by mail to The New Jersey Commission
questions related to the completion of this form, please call the Commission office at 609-633-6465.
on Brain Injury Research, 369 South Warren St., P.O. Box 360, Trenton, New Jersey 0862 5-0360. If you have
The completed form can be sent electronically to
NJCBIR@doh.nj.gov
or by mail to The New Jersey Commission
questions related to the completion of this form, please call the Commission office at 609-633-6465.
on Brain Injury Research, 369 South Warren St., P.O. Box 360, Trenton, New Jersey 0862 5-0360. If you have
Name of Institution/Organization:
questions related to the completion of this form, please call the Commission office at 609-633-6465.
Name of Institution/Organization:
1. Is this Institution/Organization capable of receiving and administering federal and state grants?
Name of Institution/Organization:
1. Is this Institution/Organization capable of receiving and administering federal and state grants?
Yes
No
1. Is this Institution/Organization capable of receiving and administering federal and state grants?
Yes
No
2. Does this institution/organization have a Grant Administration Office (or equivalent) that is responsible
for overseeing grant programs?
Yes
No
2. Does this institution/organization have a Grant Administration Office (or equivalent) that is responsible
for overseeing grant programs?
Yes
No
2. Does this institution/organization have a Grant Administration Office (or equivalent) that is responsible
for overseeing grant programs?
Yes
No
IF YES, please list the grant administrator’s name, address, and phone number:
Yes
No
IF YES, please list the grant administrator’s name, address, and phone number:
Administrator’s Name:
IF YES, please list the grant administrator’s name, address, and phone number:
Administrator’s Name:
Address:
Room:
first / middle / last
Administrator’s Name:
Address:
Room:
City:
State:
Zip:
Address:
Room:
City:
State:
Zip:
Phone:
Email:
City:
State:
Zip:
Phone:
Email:
IF NO, please explain what type of fiscal oversight structure your institution or organization has in place:
Phone:
Email:
IF NO, please explain what type of fiscal oversight structure your institution or organization has in place:
IF NO, please explain what type of fiscal oversight structure your institution or organization has in place:
BIR-1
SEP 18
Page 1 of 2 Pages.
BIR-1
Page 1 of 2
BIR-1
SEP 18
Page 1 of 2 Pages.
AUGUST 20
BIR-1
SEP 18
Page 1 of 2 Pages.
Address:
Room:
QUALIFIED RESEARCH INSTITUTION
City:
State:
Zip:
REQUEST FOR APPROVAL
Phone:
Email:
(Continued)
IF NO, please explain what type of fiscal oversight structure your institution or organization has in place:
3. What type of grants does the institution/organization hold? Please check those that apply :
QUALIFIED RESEARCH INSTITUTION
National Institutes of Health (NIH)
National Science Foundation (NSF)
QUALIFIED RESEARCH INSTITUTION
BIR-1
REQUEST FOR APPROVAL
SEP 18
Page 1 of 2 Pages.
REQUEST FOR APPROVAL
State or other Government Agencies
Private and Corporate Foundations
QUALIFIED RESEARCH INSTITUTION
(Continued)
(Continued)
REQUEST FOR APPROVAL
Other (please specify):
(Continued)
QUALIFIED RESEARCH INSTITUTION
3. What type of grants does the institution/organization hold? Please check those that apply :
REQUEST FOR APPROVAL
3. What type of grants does the institution/organization hold? Please check those that apply :
National Institutes of Health (NIH)
National Science Foundation (NSF)
(Continued)
4. Does your institution/organization provide for the protection of human subjects, animal welfare, and
3. What type of grants does the institution/organization hold? Please check those that apply :
National Institutes of Health (NIH)
National Science Foundation (NSF)
recombinant DNA molecules as regulated by the National Institutes of Health?
State or other Government Agencies
Private and Corporate Foundations
National Institutes of Health (NIH)
National Science Foundation (NSF)
State or other Government Agencies
Private and Corporate Foundations
3. What type of grants does the institution/organization hold? Please check those that apply :
Yes
Other (please specify):
No
State or other Government Agencies
Private and Corporate Foundations
Other (please specify):
National Institutes of Health (NIH)
National Science Foundation (NSF)
IF NO, please explain:
Other (please specify):
State or other Government Agencies
Private and Corporate Foundations
4. Does your institution/organization provide for the protection of human subjects, animal welfare, and
4. Does your institution/organization provide for the protection of human subjects, animal welfare, and
recombinant DNA molecules as regulated by the National Institutes of Health?
Other (please specify):
recombinant DNA molecules as regulated by the National Institutes of Health?
4. Does your institution/organization provide for the protection of human subjects, animal welfare, and
5. Does this institution/organization have in place an Institutional Review Board (IRB) that will approve
Yes
No
recombinant DNA molecules as regulated by the National Institutes of Health?
proposed research?
Yes
No
4. Does your institution/organization provide for the protection of human subjects, animal welfare, and
IF NO, please explain:
Yes
No
Yes
No
recombinant DNA molecules as regulated by the National Institutes of Health?
IF NO, please explain:
6. Please provide information on any ongoing funding that the institution/organization receives in regard to
IF NO, please explain:
Yes
No
grants. (
Attach additional sheets if necessary.)
5. Does this institution/organization have in place an Institutional Review Board (IRB) that will approve
5. Does this institution/organization have in place an Institutional Review Board (IRB) that will approve
IF NO, please explain:
proposed research?
proposed research?
5. Does this institution/organization have in place an Institutional Review Board (IRB) that will approve
Yes
No
proposed research?
Yes
No
5. Does this institution/organization have in place an Institutional Review Board (IRB) that will approve
6. Please provide information on any ongoing funding that the institution/organization receives in regard to
Yes
No
6. Please provide information on any ongoing funding that the institution/organization receives in regard to
proposed research?
grants. (
Attach additional sheets if necessary.)
grants. (
Attach additional sheets if necessary.)
6. Please provide information on any ongoing funding that the institution/organization receives in regard to
Yes
No
grants. (
Attach additional sheets if necessary.)
6. Please provide information on any ongoing funding that the institution/organization receives in regard to
grants. (
Attach additional sheets if necessary.)
7. Please provide information on any affiliation agreements with any other institutions/organizations that
ATTACH
the institution/organization may be an affiliate of. (
Attach additional sheets if necessary.)
7. Please provide information on any affiliation agreements with any other institutions/organizations that
7. Please provide information on any affiliation agreements with any other institutions/organizations that
the institution/organization may be an affiliate of. (
Attach additional sheets if necessary.)
the institution/organization may be an affiliate of. (
Attach additional sheets if necessary.)
7. Please provide information on any affiliation agreements with any other institutions/organizations that
the institution/organization may be an affiliate of. (
Attach additional sheets if necessary.)
ATTACH
7. Please provide information on any affiliation agreements with any other institutions/organizations that
the institution/organization may be an affiliate of. (
Attach additional sheets if necessary.)
BIR-1
SEP 18
Page 3 of 2 Pages.
Page 2 of 2
BIR-1
AUGUST 20
Page of 2