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Institutional Review Board

IRB Forms

General Forms

IRB Cover Sheet (Word) (PDF)

Industry Sponsored Fee Information Sheet (Word) (PDF)

Fee Waiver Request Form (Word)

Research Study Renewal Report Form (Word) (PDF)

Modification Request Form (Word) (PDF)

IRB Receipt Form (Word) (PDF)  

Reviewer Report Form (Word) (PDF)

Translator Certification (Word)

Honest Broker Assurance (Word) (PDF)

Exempt Study Review

All Applications for IRB Exempt Status Including Anonymous Use of Residual Biological Samples or Banked Tissues Samples are located on the Exempt Pages.

Reportable Events

IRB Internal Reportable Event Form for the Investigator (Word) (PDF )

IRB External Reportable Event Report Form for the Investigator (Word) (PDF )

IRB Reportable Event Form for the Reviewer (Word) (PDF)

Reportable Events Involving Risks to Subjects or Others during Research Study (Word) (PDF)

Samples

Sample consent forms can be found on our Model Consent Forms page.

Sample of Telephone Screening Script (Word) (PDF)

Sample Introductory Script (PDF)

Studies involving the Use of Radiation

Application for the Research use of Ionizing Radiation: HUSC-RSC FORM 1001 (Word) (PDF)

Instructions for Form 1002, Research use of Non-Approved (FDA) Radioactive Drug: HUSC-RSC FORM 1002 (Word) (PDF)

Application Form for the Research use of a Non-approved (FDA) Radioactive Drug: HUSC-RSC FORM 1002 (Word) (PDF)

Studies involving Gene Therapy

rDNA Application Process (http://www.rcco.pitt.edu/rdna)

Documentation Forms