Forms, Templates, Examples
Institutional Review Board (IRB) Forms, Templates & Examples
**Please be advised that the UM IRB is no longer accepting paper applications for new protocols. All new protocols must be submitted using Cayuse Human Ethics. Amendments and continuations for protocols submitted using the old system will continue to use the paper forms. Please contact the UM IRB office with questions.**
Forms
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Additional Researchers Addendum (RA-108a) |
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Continuation / Closure Report (RA-109) - Continuations approved no more than 30 days prior to expiration |
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Amendment Request (RA-110) |
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Permission to Gather Personal Health Information (HIPAA) |
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Statement of Confidentiality, signed by PI when using online survey software - submit with IRB application |
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Unanticipated Problem / Adverse Event Report (RA-111) |
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Foreign Site Study Appendix (RA-112) |
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Data Use Agreement form - use for secondary data analysis with PHI |
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Data Use Agreement form - FERPA |
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Individual Investigator Agreement - use for collaborative projects when the co-PI's company does not have an FWA |
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IRB Project Registration form - use to register a project with the UM IRB that will be overseen by another IRB |
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Templates & Examples
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Informed Consent (45 CFR 46.117) - for adults |
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Parental Permission (45 CFR 46.408(b)) |
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Minor's Assent (45 CFR 46.408(a)) - for children |
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Limits of Confidentiality |
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Examples of Approved UM Checklists/Applications |
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