ClinicalTrials.gov PRS Account Application

 Sponsor Information: The sponsoring organization is the entity with primary responsibility for initiating and conducting the study to be registered.

* Type of Organization:

Other Government

* Country:

Indonesia

* Organization Name:

National Research and Innovation Agency (Badan Riset dan Inovasi Nasional)

* Organization Address:

Gedung BJ Habibie, Lantai 18, Jalan. M.H. Thamrin No. 8, Jakarta 10320, INDONESIA

Organization Abbreviations and Acronyms:

BRIN (Badan Riset dan Inovasi Nasional)

Parent Organizations,

if any:

* Name of Individual:

Provide the name of the person representing the sponsoring organization.

Muh. Sirojul Munir

* Phone:

Please enter a valid phone number, including area code.

+62 813 8503 xxxx

* Email:

msmunir@brin.go.id

Organization Web Site (optional):

www.brin.go.id

Funding Organization:

Government of Republic of Indonesia

 

PRS Administrator Information: The PRS Administrator is the person authorized by the sponsor to update the information in the PRS will serve as the point of contact for ClinicalTrials.gov staff.

* Administrator Name:

Diar Wahyu Indriarti

Affiliation (if not the sponsor):

* Administrator Phone:

Please enter a valid phone number, including area code.

+62 816 1349 xxx

* Administrator Email:

diarwahyuindriarti@brin.go.id

 

Regulatory Information: The regulatory authority can be a national or international health authority, an institutional review board, or an ethics committee.

* Regulatory Authority:

Badan Pengawasan Obat dan Makanan (National Agency of Drug and Food Control)

* Regulatory Authority Address:

Jalan Percetakan Negara Nomor 23, Jakarta 10560, INDONESIA