Administrator Contact Request Form

OMB NO: 0925-0586 EXPIRATION DATE: 08/31/2015 Burden Statement
Each entity submitting data to must adhere to the following terms and conditions, which are intended to ensure the accuracy, currency and validity of the data.
  1. Only data for studies that are in conformance with applicable human subjects or ethics review regulations (or equivalent) and applicable regulations of the national (or regional) health authority (or equivalent) may be submitted;
  2. Notice of changes in recruitment status must be provided as soon as possible, but not later than 30 days after such changes. All other submitted data must be reviewed, verified, and updated as necessary not less than every 12 months at a minimum.
  3. The submitting organization is responsible for the completeness and accuracy of the data submitted to
  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 study data will be available to the public, although the default view will be the most recent version.
(Accept Required) Accept Do Not Accept
If your organization is already registered with, provide the following information to request contact with your organization's PRS administrator.
Organization * :
Please enter the name exactly as it appears in the list of organizations with a PRS account

Requestor Information
Name * :
Department or Group * :
Phone * :
Please enter a valid phone number, including area code.
Email * :

Questions about this form and the Protocol Registration System (PRS) may be sent to