UMMC Investigator Request to Cede IRB Review
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Name* | |
Email address* | |
UMMC Principle Investigator's name and email address (if different) | |
UMMC department | |
Scope of UMMC's engagement (select all that apply)* |
If other: |
Attach study protocol | *.txt,*.doc,*.docx,*.xls,*.xlsx,*.pdf, *.gif,*.jpg,*.jpeg,*.bmp,*.png,*.tif,*.tiff |
Name of the external IRB (institution) upon which you are asking to rely* | |
Title of the study* | |
A lay description of the study and study aims* | |
Funding source or sponsor of the study* | |
Method of agreeing to reliance* | |
Please work with the external IRB's administrative staff to answer the
following questions: |
External IRB's Federalwide Assurance Number* | |
Expiration date* | |
External IRB point of contact information* | |
Confirmation that the external IRB is in good standing with OHRP and FDA (no recent warning letters, no open investigations)* | |
Confirmation that the external IRB is located within the U.S.* |
STOP HERE - Please contact the Human Research Office
at umcirb@umc.edu before proceeding further.
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Confirmation that the external IRB has applicable policies and procedures in place* | |
Whether the IRB has elected to extend its FWA to all research* | |
Confirmation that the external IRB is AAHRPP-accredited* |
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Human Research Office
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Please attach study Informed Consent Form template (if applicable) so that UMMC’s institutional language requirements can be reviewed or inserted by the Human Research Office* | *.txt,*.doc,*.docx,*.xls,*.xlsx,*.pdf, *.gif,*.jpg,*.jpeg,*.bmp,*.png,*.tif,*.tiff |
Please note: once permission to cede IRB review of the study has been granted, the study still needs to be submitted in Cayuse and receive a local administrative review prior to initiating conduct of the study. |
For any questions regarding this form or IRB reliance, please reach out to the Human Research Office
at umcirb@umc.edu. |
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