Institutional Review Board Application Form

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Enter date of training:
Student  Faculty  Staff  
New project
Revised Project
Renewal
If revised or renewal, please enter project ID #:
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If yes, please identify the funding source:
Exempt Review (no direct human subject involvement)
Expedited Review (direct human subject involvement includes only adults and minimal risk)
Full Board Review (direct human involvement including children, prisoners, or medical and higher risk experimental designs)
Research conducted in established or commonly accepted educational settings and involving normal educational practices such as (i) research on regular and special education instructional strategies, or (ii) research on the effectiveness of or the comparison among instructional techniques, curricula, or classroom management methods.
Research involving the use of survey procedures, educational tests (cognitive, diagnostic, aptitude, achievement), interview procedures or observation of public behavior, if (i) information from these sources is recorded in such a manner that participants cannot be identified, directly or through identifiers linked to the subjects; and (ii) any disclosure of the human subjects' responses outside the research could not reasonably place the subjects at risk of criminal or civil liability or be damaging to the subjects' financial standing, employability, or reputation. Note: This category cannot be used for research involving children
Research involving the use of survey procedures, educational tests (cognitive, diagnostic, aptitude, achievement), interview procedures, or observation of public behavior, if (i) the human subjects are elected or appointed public officials or candidates for public office; or (ii) federal statute(s) require(s) without exception that the confidentiality of the personally identifiable information will be maintained throughout the research and thereafter.
Research involving the collection or study of existing data, documents, records, pathological specimens, or diagnostic specimens, if these sources are publicly available or if the information is recorded by the investigator in such a manner that subjects cannot be identified, directly or through identifiers linked to the subjects.
_Research and demonstration projects which are conducted by or subject to the approval of federal department or agency heads, and which are designed to study, evaluate, or otherwise examine (i) Public benefit or service programs; (ii) procedures for obtaining benefits or services under those programs; (iii) possible changes in or alternatives to those programs or procedures; or (iv) possible changes in methods or levels of payment for benefits or services under those programs.
Research poses no more than minimal risk to subjects (defined as "the probability and magnitude of harm or discomfort anticipated in the research not greater in and of themselves than those ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests.")
Research limited to one or more of the following data collection procedures (check all below that apply):
Collection of data through noninvasive procedures routinely employed in clinical practice;
Research involving materials (data, documents, records, or specimens) that have been collected, or will be collected solely for non-research purposes;
Collection of data from voice, video, digital, or image recordings made for research purposes;
Research on individual or group characteristics or behavior (including, but not limited to, research on perception, cognition, motivation, identity, language, communication, cultural beliefs or practices, and social behavior) or research employing survey, interview, oral history, focus group, program evaluation, human factors evaluation, or quality assurance methodologies; Note: Some research in this category may be classified as exempt; this listing refers only to research that is not exempt.
Continuing review of research previously approved by the convened HSRB as follows: (a) where (i) the research is permanently closed to the enrollment of new subjects; (ii) all subjects have completed all research-related interventions; and (iii) the research remains active only for long-term follow-up of subjects; or (b) where no subjects have been enrolled and no additional risks have been identified; or (c) where the remaining research activities are limited to data analysis.
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I am requesting permission to waive written consent, based on one or more of the following categories (check all that apply):
The only record linking the subject and the research would be the consent document, and the principal risk would be potential harm resulting from a breach of confidentiality.
The research presents no more than minimal risk of harm to subjects and involves no procedures for which written consent is normally required outside of the research context.
I will be using a written consent form. Attach a copy of the written consent form with this application.
A copy of your training certificate (required for principal investigator)
Surveys, questionnaires, and/or interview instruments
Informed consent forms or statements
Letters of approval from cooperative agencies, schools, or education boards
Debriefing statements or explanation sheet
Detailed narrative project description