UConn Health Center HomeHuman Subjects Protection Office
HOME EDUCATION AND RESOURCES FREQUENTLY ASKED QUESTIONS CONTACT US
 

Institutional Review Board Instructions, Forms, and Samples

There are currently three IRB panels constituted at the Health Center that meet on a monthly basis. Panel 01 meets for the first convened meeting of the month, Panel 02 meets for the second convened meeting of the month and Panel 3 meets for the third convened meeting of the month. With one exception studies requiring full board review are initially assigned to Panel 01, 02 or 03 based on submission date of the application. The one exception is that any study proposing to involve prisoners as subjects (including via chart reviews) must be reviewed by Panel 02 which has a prisoner advocate as a member. Once a study has been assigned to a panel it remains under that same panel's oversight for the life of the study. IRB Panel 4 meets on an as needed basis and only reviews studies involving research with embryonic stem cells.

All documents submitted to the IRB must be typed. Cells on the forms will expand to accommodate text. If you cannot access the documents, experience a problem with the formatting, or have general questions about preparing a submission to the IRB contact any of the following individuals for assistance:

Name
Phone
Area of Focus
Patricia Gneiting 860-679-4849 Expedited and Exempt Submissions
Donna Horne 860-679-4851 Full Board Panel 2 or 3 Submissions
Pamela Colwell 860-679-1019 Full Board Panel 1 or 3 Submissions
Marcy Chasse 860-679-8729 Outgoing Correspondence to PIs

 

For each submission, save the relevant documents to your hard drive and complete accordingly. Always refer back to the web site or the shared Institutional Review Board e-mail folder when submitting forms to the IRB to ensure you are using the most recent version of the document. The IRB reserves the right to return outdated forms. A log describing changes that have been made is available at the bottom of the page.

Human Subjects Training

All key personnel associated with a study, including those authorized to obtain consent, must complete human subjects training. Completion of this training will be verified by the IRB Office. New investigators and research personnel who have not yet completed training or whose training is more than 3 years old are also required to complete the CITI Basic Course Requirement and submit the completion certificate to the Human Subjects Protection Office. Biomedical investigators whose initial CITI training is expiring must complete the CITI GCP course. Social and behavioral investigators whose initial CITI training is expiring must complete the CITI social and behavioral refresher course.

Starting the IRB Process

Your research protocol should be well formulated before you being the process of preparing an IRB application. The first step is to determine whether you study will require review by the full board or whether it will qualify for expedited review or exempt status. To make this determination first review the categories of research that may qualify for an exempt status. If the research does not appear to qualify for exempt status, review the categories of research that may be permitted under expedited review. If the research does not appear to qualify for exempt status or expedited review, full board review will be required and the submission deadlines will apply. Once you determined the type of review that is required you should review the Checklist for Initial and Continuing review and prepare/provide those documents that are relevant to your study. The checklist also tells you how many copies of each document must be provided. Use this checklist to communicate with the IRB if you need to convey information about your submission. If items on the checklist do not pertain to your study indicate NA. Once all of your material is complete it is submitted in hard copy format to the IRB office. It can be addressed to the IRB, 2nd floor Munson Building at MC-3926 and sent via interoffice mail or through the courier service, or it can be hand delivered. The IRB staff will the screen the submission and communicate with you via e-mail regarding any needs for additional information or clarifications.

All documents are in Word format unless otherwise noted.

Forms for Determining Whether IRB Review is Required
Human Subject Research Determination Form (June 26, 2009)
Quality Improvement/Performance Improvement Determination Form
Instructions for IRB Applications, Closures, Continuations, Modifications
Instructions for Application for Initial and Continuing (revised July 11, 2008)
Instructions for Addendum to Application to Request Continuing Review (April 8, 2008)
Instructions for Application for Registry/Repository (March 6, 2006)
Instructions for Appendix B, Application for DSMP/B (August 15, 2005)
Instructions for Request for Closure/Completion (August 15, 2005)
Instructions for Request for Modification (March 2, 2009)
Instructions for Application for Expedited Continuation Under Category 8A or 8C Only (September 17, 2009)
Routine IRB Forms (Application, Closure, Continuing Review, Modification Review etc.)
Checklist for Initial and Continuing Review (September 10, 2009)
Application for Initial and Continuing Review (March 2006)
Application Addendum to Request Continuing Review (March 7, 2007)
Application for Expedited Continuation Under Category 8A or 8C Only (September 17, 2009)
Application Appendix A (GCRC Resource Request) (June 29, 2009 by GCRC)
Application Appendix B (DSMP/B Template) (August 15, 2005)
Application Appendix C (UConn Health Center as Coordinating, Lead or Statistical Center) (August 15, 2005)
Application Appendix D (Enrollment Targets) (January 15, 2009 by GCRC)
Conflict Disclosure Form
IDE Statement of Investigator Obligations
IND Statement of Investigator Obligations
Principal Investigator's Appointment of Personnel for Coverage
Request for Exemption (July 8, 2008)
Request for Expedited Review (August 15, 2005)
Request for Modification (March 2, 2008)
Request for Study Closure/Completion (August 15, 2005)
Individual Investigators Agreement
Problem Report Form (August 5, 2009)
Participant Feedback Form (new stand alone form March 2, 2009)
IRB Templates for Standard Consent/Assent and Requests for Waivers
Informed Consent Checklist ( May, 2009)
Informed Consent Checklist - Genetic Research Addendum
Informed Consent Checklist - Stem Cell Research Addendum
Standard Informed Consent Template (May, 2009)
Short Form Consent Documents (from the University Minnesota)
Assent Document (from the University of Massachusetts)
Assent Document (from the University of California, Los Angeles)
Acceptable Contract Vs. Consent Language
Sample Pregnancy Language for Inclusion in Consent Forms
Request for Waiver or Alteration to Requirements of Consent ( January 2007)
Request for Waiver or Alteration of Consent for Projects Conducted by or Subject to the Approval of State or Local Government Officials (March 2006)
Request for Waiver of Consent for Planned Emergency Research (March 2006)
Request to Waive Documentation of Consent (March 2006)
Participant Feedback Form (new stand alone form March 2, 2009)
Genetic Information Non-Discrimination Act (GINA) Handout (new May 2009)
HIPAA Forms
HIPAA Authorization to Use and Disclose (September 26, 2007)
HIPAA Authorization to Add PHI to a Research Registry (October 2007)
HIPAA Request for Waiver of Authorization
HIPAA Certification of De-Identification
HIPAA Assurance of Preparatory to Research or Decedent Research
HIPAA Limited Data Set Certification
HIPAA Data Use Agreement (external)
Protocol - Sample Documents
Protocol Design - ICH Guidelines - Chapter 6 (PDF)
Guidelines for Writing a Protocol
Vulnerable Populations
Protections for Pregnant Women, Fetuses and Neonates - Forms B204-207 (February 25, 2009)
Protections for Prisoners - Form C (February 25, 2009)
Protections for Children/Decisionally Impaired Adults - Form D404-407 (February 25, 2009)
Protections for Other Vulnerable Groups - Form S (February 25, 2009)
Tracking - IRB Templates
Adverse Event Log
Protocol Deviation Log
Registries/Repositories
Application for Registry/Repository Initial and Continuing Review (March 6, 2006)
Application Addendum for Registry/Repository Continuing Review
Sample Consent for Registry (September 17, 2009)
Sample Protocol for Research Registry (PDF, from the University of Pittsburgh)
Sample Protocol for Research Registry (from the New York University Medical School)
Humanitarian Use Device*
Humanitarian Use Device Application Form
Humanitarian Use Device Consent Template (RTF)
Humanitarian Use Device Continuation Form
Humanitarian Use Device Modification Form
Miscellaneous Documents
Adverse Event Reporting Policy - Memo for Sponsors
Guidelines for Assessing Risk
Guideline for Describing Probability of Side Effects in Informed Consent Forms
Sample IRB Key Personnel Training Letter
Brochures
Employee Orientation (PDF version)
Rights and Responsibilities of Research Volunteers - English (PDF version)
Rights and Responsibilities of Research Volunteers - Chinese (PDF only)
Rights and Responsibilities of Research Volunteers - French (PDF version)
Rights and Responsibilities of Research Volunteers - German (PDF version)
Rights and Responsibilities of Research Volunteers - Greek (PDF version)
Rights and Responsibilities of Research Volunteers - Italian (PDF version)
Rights and Responsibilities of Research Volunteers - Polish (PDF version)
Rights and Responsibilities of Research Volunteers - Portuguese (PDF version)
Rights and Responsibilities of Research Volunteers - Russian (PDF version)
Rights and Responsibilities of Research Volunteers - Spanish (PDF version)
Student Tips (PDF version)
Document Change Reference Log
Change Log (Excel, September 17, 2009)


*Also review sections for routine IRB forms, HIPAA forms and vulnerable populations for additional forms that may be required (e.g., checklist, HIPAA authorization, appendices, etc.)

  
A-Z INDEX        UCONN HEALTH CENTER        TEXT-ONLY © University of Connecticut Health Center
Disclaimer   Privacy Notice
Maps & Directions