Animal Welfare Assurance for Foreign Institutions
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Name of Institution: |
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Address: (street, city, state, country, postal code)
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This Institution agrees to comply with the Public Health Service (PHS) Policy on Humane Care and Use of Laboratory Animals (Policy), or provide evidence that acceptable standards for the humane care and use of the animals in PHS-conducted or supported activities will be met.
This Animal Welfare Assurance for Foreign Institutions (Foreign Assurance) is applicable to all research, research training, and biological testing activities involving live, vertebrate animals supported by the PHS and conducted at this Institution, or at another Institution as a consequence of the sub-granting or subcontracting of a PHS-supported activity by this Institution. [List all entities, such as hospitals, separate institutes or centers that will be covered by this Foreign Assurance] (must complete this section)
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This Institution is guided by the International Guiding Principles for Biomedical Research Involving Animals (PDF). This Institution will comply with all applicable provisions of the following laws, regulations, and policies governing the care and use of laboratory animals. [List titles in English of all governing laws, regulations, and policies for your jurisdiction] (must complete this section)
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This Institution acknowledges and accepts responsibility for the care and use of animals involved in activities covered by this Foreign Assurance. As partial fulfillment of this responsibility, this Institution will make a reasonable effort to ensure that all individuals involved in the care and use of laboratory animals understand their individual and collective responsibilities for compliance with all applicable laws, regulations, and policies pertaining to animal care and use.
Check one: (must complete this section)
[��� ]� This Institution is accredited by AAALAC International.
[��� ]� This Institution is not accredited by AAALAC International.
Check one: (must complete this section)
[��� ]� This Institution is accredited by Canadian Council on Animal Care.
[���
]� This Institution is not accredited by Canadian Council on Animal
Care.
This institution agrees to notify OLAW when contact information changes. This information can be e-mailed to olawdoa@mail.nih.gov or sent by fax to: +1 (301) 451-5672. Include Foreign Assurance number in all correspondence.
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IV. Institutional Endorsement and PHS Approval
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A.� Authorized Institutional Official (must complete this section) |
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Name: ���� |
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Title:���� |
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Name of Institution: |
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Address: (street, city, state, country, postal code)
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Phone:���� |
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E-mail:���� |
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Signature:���� |
Date:���� |
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B.� PHS Approving Official (to be completed by OLAW) |
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Name/Title: Office of Laboratory Animal Welfare (OLAW) National Institutes of Health 6705 Rockledge Drive RKL1, Suite 360, MSC 7982 Bethesda, MD� USA� 20892-7982 (FedEx Zip Code 20817) Phone: +1 (301) 496-7163 Fax: +1 (301) 451-5672 |
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Signature: |
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Foreign Assurance Number: |
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Effective Date: |
Expiration Date: |
Two additional Institutional contacts are required. Examples include: chairperson, animal or review committee member, institutional representative, regulatory official, veterinarian or grants official. (must complete this section)
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Contact #1 |
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Name:���� |
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Title:���� |
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Name of Institution: |
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Address: (street, city, state, country, postal code)
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Phone:���� |
Fax:���� |
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E-mail:���� |
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Contact #2 |
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Name:���� |
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Title:���� |
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Name of Institution: |
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Address: (street, city, state, country, postal code)
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Phone:���� |
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E-mail:���� |
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��������� [Note: please notify OLAW at olawdoa@mail.nih.gov when contact information changes.]