Submission Forms:

  Amendment Form
    (v05/01/09)
    .rtf.rtf    .doc.doc

 Application for
    Non-Research
    Student Projects
    (v05/01/09)
    .rtf.rtf    .doc.doc

 Application for
    Non-Human Subjects
    Research- (v05/01/09)
    .rtf.rtf    .doc.doc


  Assent Templates:

 Assent To Participate
    in Research Template
    (v05/01/09)
    .rtf.rtf    .doc.doc

 Assent To Participate
    in Research Template
    Spanish - (v05/01/09)
    .rtf.rtf    .doc.doc


  Authorization Templates:

Authorized Medical
   Record Request Form
    .rtf.rtf    .doc.doc

  Authorization -
    Template for the
    Release of Health
    Information
    (v05/01/09)
    .rtf.rtf    .doc.doc

  Authorization -
    Template for the
    Release of Health
    Information
    Spanish - (v05/01/09)
    .rtf.rtf    .doc.doc

  Authorization -
    Healthy Subjects
    (v05/01/09)
    .rtf.rtf    .doc.doc

  Authorization -
    Healthy Subjects
    Spanish - (v05/01/09)
    .rtf.rtf    .doc.doc

  Authorization -
    Minors Template
    (v05/01/09)
    .rtf.rtf    .doc.doc

  Authorization -
    Minors Template
    Spanish - (v05/01/09)
    .rtf.rtf    .doc.doc


  Checklist for
    Determining Whether
    an Activity Requires
    IRB Reviews
    (v05/01/09)
    .rtf.rtf    .doc.doc

 Co-Investigator
   Update Form
   (v05/01/09)
    .rtf.rtf    .doc.doc


  IRB Continuing Review
  and Closeout Forms:


 Continuing
   Review/Closeout
   Report Instructions
   (v05/01/09)
    .rtf.rtf    .doc.doc

 Continuing Review
   Open to Enrollment
   (v08/01/09)
    .rtf.rtf    .doc.doc

 Continuing Review
   Closed to Enrollment
   (v08/01/09)
    .rtf.rtf    .doc.doc

 Closeout Report
   (v05/01/09)
    .rtf.rtf    .doc.doc


 Covered Entity
   Checklist (v05/01/09)
    .rtf.rtf    .doc.doc

 Documentation of
   Review and Approval
   (DRA) (v05/01/09)
    .rtf.rtf    .doc.doc

 Exempt Research
   Checklist (v05/01/09)
    .rtf.rtf    .doc.doc

 Expedited Research
   Checklist (v05/01/09)
    .rtf.rtf    .doc.doc

 IDE Checklist
   (v05/01/09)
    .rtf.rtf    .doc.doc

 IND Checklist
   (v05/01/09)
    .rtf.rtf    .doc.doc


  Informed Consent:

 Informed Consent
   Checklist (v05/01/09)
    .rtf.rtf    .doc.doc

 Informed Consent
   Template (v05/01/09)
    .rtf.rtf    .doc.doc

 Informed Consent
   Template- Spanish
   (v05/01/09)
    .rtf.rtf    .doc.doc

 Delegation of
   Authority to Consent
   (v05/01/09)
    .rtf.rtf    .doc.doc

 Request Form for
   Waiver of Informed
   Consent for Planned
   Emergency Research
   (v05/01/09)
    .rtf.rtf    .doc.doc


 NCI CIRB Facilitated
   Review Form
   (v05/01/09)
    .rtf.rtf    .doc.doc

 NCI CIRB Review
   Cover Sheet
   (v05/01/09)
    .rtf.rtf    .doc.doc

 Noncompliance
   Reporting Form
   (v05/01/09)
    .rtf.rtf    .doc.doc

 Prompt Reporting
   Form (v05/01/09)
    .rtf.rtf    .doc.doc

 Protocol Template
   (v05/01/09)
    .rtf.rtf    .doc.doc

 Recruitment Checklist
   (v05/01/09)
    .rtf.rtf    .doc.doc

 Summary Safeguard
   Statement (SSS)
   (v05/01/09)
    .rtf.rtf    .doc.doc

  Vulnerable Population
  Request Forms:


 Request Form for the
   Inclusion of Children
   in Research
   (v05/01/09)
    .rtf.rtf    .doc.doc

 Request Form for the
   Inclusion of Cognitively
   Impaired Individuals in
   Research (v05/01/09)
    .rtf.rtf    .doc.doc

 Request Form for the
   Inclusion of Pregnant
   Women, Human
   Fetuses and Neonates
   in Research
   (v05/01/09)
    .rtf.rtf    .doc.doc

 Request Form for the
   Inclusion of Prisoners
   in Research
   (v05/01/09)
    .rtf.rtf    .doc.doc

  VA Research Forms:

VA Research Project
   Submission Checklist
    .rtf.rtf    .doc.doc

 VA Waivers for
   Recruitment
   (v05/01/09)
    .rtf.rtf    .doc.doc

Investigator
   Data Sheet -
   VA Form 10-5368
    .rtf.rtf    .doc.doc

Project Data Sheet -
   VA Form 10-1436
    .rtf.rtf    .doc.doc

VA Data Security
   Appendix (C-D)
    .rtf.rtf    .doc.doc

VA R&D Committee
   Research Study
   Submission Form
    .rtf.rtf    .doc.doc

Application for An
   Off-Site Tissue
   Banking Waiver -
   VA Form 10-0436
    .rtf.pdf

VA Consent Form -
   VA Form 10-1086
    .rtf.rtf    .doc.doc

Investigational Drug
   Information Record -
   VA Form 10-9012
    .rtf.rtf    .doc.doc

Research Protocol
   Safety Evaluation -
   VA Form 10-0398
    .rtf.rtf    .doc.doc

Pathology and
   Laboratory Impact
   Estimation Worksheet
    .rtf.rtf    .doc.doc

Memo for Authorization
   to Transport VA
   Sensitive Information
    .rtf.rtf    .doc.doc

  WIRB (Western
  Institutional Review
  Board) Forms:


WIRB Standard
   Operating Procedures
    .rtf.rtf    .doc.doc

WIRB Eligibility
   Checklist
    .rtf.rtf    .doc.doc

IU Application for
   Protocol Review by
   WIRB
    .rtf.rtf    .doc.doc

Authorization for the
   Release of Health
   Information
   (v05/01/09)
    .rtf.rtf    .doc.doc

Authorization for the
   Release of Health
   Information - Spanish
   (v05/01/09)
    .rtf.rtf    .doc.doc

IU WIRB Informed
   Consent Template
    .rtf.rtf    .doc.doc

WIRB Initial Review
   Submission Form
    link WIRB Website Forms

WIRB Investigator
   Submission Form for
   Multi-Center Protocols
    link WIRB Website Forms


Contact us: Research Compliance Administration