GME New Affiliation Agreement Request

Type of Affiliation Agreements:

  1. Letter of Agreement (LOA): Used for one trainee, limited to the dates of the rotation. (typically used for elective rotations for a minimum of two-weeks and maximum of 1year)
  2. Training Affiliation Agreement (TAA): Used for multiple trainees going to the site for one or multiple rotations. This is used for long term, ongoing, or required rotations your program has at other sites. This is valid for 5 years at a time and can be renewed.


Please read the instructions below and attach the proper documentation before submitting this Smartsheet form. Each required attachment is linked below for you to download.


FOR AN LOA PLEASE SUBMIT:


  • The Smartsheet form on the right for an LOA and submit the following attachments:


(One of the following four documents SIGNED by the Other Institution WITH NO CHANGES)

  1. Outgoing domestic letter of agreement
  2. Outgoing international letter of agreement
  3. Incoming domestic letter of agreement
  4. Incoming international letter of agreement

In addition please also submit:


If the other institution is requesting changes to our LOA standard language, OR the other institution is requiring us to sign their LOA form your LOA request must go through our contracts office for review and signatures.


This process through contracts can take 4-6 months to be resolved**



FOR A TAA POLEASE SUBMIT



  • Smartsheet form on the right for a TAA**
  • A completed Program letter of agreement for the rotation signed by the Site Director.
  • Rotation goals and objectives


Once this Smartsheet form is submitted, you will receive a confirmation email with the follow-up timeline. All TAA requests should be submitted at least 4-6 months in advance of rotation start date. LOA requests should be submitted no later than 30 days prior to rotation start date.**


**Your program should always have an alternate rotation available for your trainee in case negotiations are not resolved or an agreement cannot be reached between the two sites.


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If you are unsure of which forms to use, please see below for more information on Affiliation Agreements.



When and how to use an LOA:

  • An LOA is a set form that has been approved by UCSF risk management, legal and contracts departments
  • Only requires the signatures of the other institution and Kathy Julian (UCSF DIO) if changes are not made to the document by the other institution
  • If no changes are made to the document, process can be quick and signed by both parties within one week
  • If changes are made to the other institution to any of the legal language, the form must then be sent to the UCSF contracts and legal department for review and can take up to three months for approval.


When and how to use a TAA:

  • A TAA is an agreement between UCSF and another institution that is sent through our contracts department and is negotiated by both legal teams until the language is agreed upon
  • TAA is required for permanent away rotations
  • Process for negotiations can take up to six months

UCSF Program Contact Information


Affiliation Agreement Information

Please review the current list of Affiliation Agreements


Is the other institution included in the current list of Affiliation Agreements above?

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Active Affiliations or Agreements Under Negotiation

If the Other Institution is included in the current list of Affiliation Agreements you do not need to submit a new LOA or TAA form.


Please only submit the following in the attachment section below:

  1. UCSF Program letter of agreement
  2. Rotation goals and objectives


***AFFILIATIONS UNDER NEGOTIATION*** UCSF policy requires a service agreement status of "Completed" prior to rotation activities taking place.


OGME unfortunately has no control over how long negotiations take, please check in with us at least 1 month prior to your rotation starting to ensure your trainee is cleared to go to the affiliated site. Your program should plan on alternate rotations in case negotiations are not resolved by the rotation start date.


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Please describe the length of rotation (i.e. 2 weeks, 1 month, 1 year), the frequency, is this an annual rotation etc.

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Please explain why you chose "Other - please explain" above. Describe the number of trainee's that go through this rotation.

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Please explain in detail why the other institution has not signed

**UCSF will not sign without prior signature from Affiliate Instituion**

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Changes to UCSF LOA agreement Form


If the other institution is requesting changes to our LOA standard contract, OR the other institution is requiring us to sign their institution's LOA form, your LOA request MUST go through our contracts office for review and signatures.


**This process through contracts can take 4-6 months to be resolved**


OGME unfortunately has no control over how long negotiations take between institutions. Please check in with us at least 6 weeks prior to your rotation starting to ensure your trainee is cleared to go to the affiliated site.


Your program should always have an alternate rotation available for your trainee in case negotiations are not resolved or an agreement cannot be reached between the two sites.


Other Institution Contact

All TAAs must go through our contracts office for review and signature.


OGME unfortunately has no control over how long negotiations take between institutions. Please check in with us at least 6 weeks prior to your rotation starting to ensure your trainee is cleared to go to the affiliated site.


Your program should always have an alternate rotation available for your trainee in case negotiations are not resolved or an agreement cannot be reached between the two sites.

Please provide the name of the contact that will be working with our UCSF contracts team to execute this request for signatures on their end.

Phone

LOA Required Documents

Please fill in all sections highlighted in YELLOW on the LOA Form and obtain signature from the other institution. Links to forms are listed on the LEFT.


**If the other institution is making changes to the document please make sure Microsoft Word 'track changes' is on.**


Please submit one of the four following documents:

  1. Outgoing domestic letter of agreement
  2. Outgoing international letter of agreement
  3. Incoming domestic letter of agreement
  4. Incoming international letter of agreement


In addition to:

  • Program letter of agreement
  • Rotation goals and objectives
  • Affiliation Request Form


*Any delay in providing all required documents will result in a delay processing your request.

TAA Required Documents

  1. All required information requested above.
  2. A completed Program letter of agreement for the rotation signed by the Site Director.
  3. Rotation goals and objectives.


An agreement with UCSF Contracts will be initiated with the information provided in the Affiliation Request Form. Please complete this form in its entirety so Contracts can contact the other institution to initiate the legal agreement.


*Any delay in providing all required documents will result in a delay processing your request.

Active Affiliations Required Documents

If the Other Institution is included in the current list of Affiliation Agreements you do not need to submit a new LOA or TAA form.


Please only submit the following in the attachment section below:

  1. UCSF Program letter of agreement
  2. Rotation goals and objectives

Please select all attachments you are including with this request.


Only submit the required attachments based on your choices above.

Please ensure all attachments checked off above are included with your request.

Drag and drop files here or