Global Contract Triage: Request Form (New)
* If you receive a 4. Create Bid History (Agreement) Request error after submitting this form, please double check to make sure that the Opportunity Number (Project Code) is correct.
Internal Use Only
Requestor Information:
Requestor Name
Requestor Email
Project Information:
Contract Document Type
Please select...
New Change Order
CNF
Change Order Ballpark
Preliminary Agreement Amendment
LRA
LRA Amendment
Is this a Study Cancellation
Please select...
Yes
No
Study Cancellation Reason
Please select...
Company Closing
Funding
Moved to Competitor
Operational Changes
Portfolio Reprioritization
Pulled Study In-House
Study Design
Safety/Efficacy Data
Other
Other Cancellation Reason
Is any portion of this related to a BCP?
Please select...
Yes
No
As we have seen the events unfold in Ukraine/Russia, GBO has been working with IQVIA stakeholders to review the impact the situation has had on our studies in these regions. Commencing 01 April, Project Leadership (PL), will be initiating Change Notification Forms (CNF), and/or, Change Orders (CO), updating studies that are in Ukraine/Russia.
Customer Name (Client/Sponsor Name)
Opportunity #:
CRM Opportunity # (e.g. XYZ12345)
Project Code (if applicable):
FSP Project Code OR Financial Project Code
x
Protocol # (if applicable):
IQVIA Project Leader Name:
Clinical Project Manager (CPM) / Technical Project Manager (TPM) / Project Manager (PM)
IQVIA Project Leader Email
IQVIA Project Leader Region:
Please select...
Asia Pacific
USA/Canada
Europe/Middle East/Africa EMEA
Japan
Latin America
Ranking
Please select...
1) Change Does Not Impact Budget (ie: text changes only, Local / Legal Rep Agreement) or a Consultancy Agreement
2) Change Impacts 1 Service Only / No Third Party Vendors (TPV)
3) Change Impacts 2-3 Services / Several CNF's or CO Log / < 2 TPV
4) Change Impacts > 4 Services / ≥ 3 TPV
5) Award Has Service Fees > USD $50M / Program With Multiple Studies / Study Has Multiple QIP Budgets
Does the CO include Third Party Vendors?
Please select...
Yes
No
Budgetary Impact to Third Party Vendors?
Please select...
Yes
No
Links to Forms:
LRA Checklist
IQVIA Biotech NOBI SMF Form
IQVIA Biotech UPT SMF Form
Please go to Project Operations within
Knowledge Network
and in the search bar, type in only a "few words" to retrieve the following forms below:
Biogen Car Form Biogen LDP Specification Form
Scope Summary Form ICOF Form
ITAB Form RWE ICOF Form
Takeda Checklist Form UPT ICOF Form
Is your budget created in QIP, NOBI, POP, Outcome, IntegRate, or UPT?
Yes
No
LRA checklist completed and attached?
No
Yes
Attach SSF / RWLFP- ICOF / LRA Checklist / BIOTECH SMF Form / CAR Form / Takeda Checklist
Attach ICOF / Infosario Outcome Change Order Form
Attach a document.
Comment Box:
[Please include details such as: Sequential reference number (eg. CNF-5), Local language, if not English? What is the pricing tool? Ie: QIP, Outcome, Rate Table, etc; If required, have you uploaded your completed SSF/ICOF, CNF, LRA Checklist Form?]
Change Order Number
Allowed only number between 0 and 99. What Change Order number does this CNF correspond to?
Change Notification Form (CNF) Completed?
No
Yes
If this is a CO, have there been previously approved scope change requests (eg. CNF, CO Log, CORF, SCF, etc.)?
x
Attach Form:
Attach Another Document
CNF Comment Box:
Please include details such as: Sequential reference number (eg. CNF 5)
Additional Comment Box
Please include details such as: Sequential reference number (eg. CNF 5), Local Language, Eg. Email approval, threshold, etc.
Contact Information