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ATTACHMENT #3: DRAFT MEMO AND GENERIC INVOICE

MEMO:

Please send the information requested below to the following address: (Please do not send this information to the University of Iowa Sponsored Programs.)

IHAST2 CCC
6505-5 JCP
Dept. of Anesthesia
University of Iowa
Iowa City, IA 52242
Purpose: The purpose of this Memo is to provide information to each subcontracting institution on reimbursement procedures.

To assist the University of Iowa in providing payment to a subcontracting center, we request that each center send an invoice to the University of Iowa Clinical Coordinating Center (CCC). This invoice will be used by the IHAST2 CCC to initiate payment for work done by the subcontracting institution. Upon receiving notice from the University of Iowa Data Management Center (DMC) that a complete data set (for an enrolled patient in the IHAST2 trial) has been received, the CCC will send a copy of the Subcontracting Center’s Invoice to the University of Iowa Grant Accounting. Prior to sending the invoice, the CCC will fill in the Amount Due for work done during the pay period.

Providing the University of Iowa CCC with this invoice will expedite payment of your center and decrease the workload of the investigators.

The invoice should be created on the subcontracting university’s letter head and should contain the following information:

  1. The subcontracting institution’s Purchase Order Number. The Purchase Order Number may be found at the top right-hand corner of the "Subcontract Under National Institute of Health Grant".
  2. A space for an invoice number (this will be filled in at the CCC).
  3. A description of the project and worked perform as follows: "The following payment is for work done for the University of Iowa study entitled HYPOTHERMIA DURING INTRACRANIAL ANEURYSM SURGERY. Payment is for start-up costs, and for successfully randomized and managed patients."
  4. A space for Amount Due (this will be filled in at the CCC).
  5. The signature from your institution.
Following is a template for your invoice:
 

YOUR INSTITUTION’S LETTER HEAD

TO: The University of Iowa

PURCHASE ORDER NUMBER:_______________ INVOICE NUMBER: ________

The following payment is for work done for the University of Iowa study entitled, HYPOTHERMIA DURING INTRACRANIAL ANEURYSM SURGERY. Payment is for start-up costs, and for successfully randomized and managed patients."

AMOUNT DUE: ________

SIGNATURE: _____________________________ 

Please send the invoice to the CCC at the address listed above.

______________________________________________________

If you did not receive an email on December 1st, you or your university has already sent us a "Generic Invoice". We thank you for attending to this.

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