Human Research Protection Program

Forms

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Exemption Request Forms PDF Document Word Document
Category 1
Research conducted in educational settings, involving normal educational practices adobelogo MSWORD
Guidelines to determine eligibility
Category 1 Description
Category 2
Research involving the use of educational tests, survey procedures, interview procedures or observation of public behavior adobelogo MSWORD
Category 2 Description
Category 3
Research using category 2 study procedures that is not exempt under Category 2 IF: (see Category 3 description) adobelogo MSWORD
Category 3 Description
Category 4
Research involving the collection or study of existing data, documents, records, pathological or diagnostic specimens adobelogo MSWORD
Category 4 Description
Category 5
Research and demonstration projects on public benefits and service programs (NOTE: This category applies only to activities conducted pursuant to a federal statutory authority). If you feel your research meets the criteria for category 5, please contact the IRB Administrator
Category 5 Description
Category 6
Taste and food quality evaluation and consumer acceptance studies adobelogo MSWORD
Category 6 Description



Non-Exempt Research Application Forms for Expedited or Full Review PDF Document Word Document
Application Form adobelogo MSWORD



Amendments to Approved Studies PDF Document Word Document
Amendment to Approved Study adobelogo MSWORD
Personnel Amendment to Study adobelogo MSWORD



Consent/Assent Templates

-The Consent Form and Assent Form include special instructions in orange italics
-Replace italics on form as needed (Tab key will not navigate through fields)
PDF Document Word Document
Consent Form (template only) adobelogo MSWORD
Consent Form Instructions adobelogo MSWORD
Sample Assent Form adobelogo MSWORD



Unanticipated Problem/Adverse Event Reporting PDF Document Word Document
Reporting Form adobelogo MSWORD
Decision Tree adobelogo MSWORD



HIPAA Forms PDF Document Word Document
Authorization for Release of PHI (Non-Purdue Covered Entities) adobelogo MSWORD
Authorization for Release of PHI (Purdue Components) adobelogo MSWORD
Request for Waiver of Authorization or Modification of Authorization adobelogo MSWORD
Activities Preparatory to Research Waiver adobelogo MSWORD
Use of Decendent's Information Certification adobelogo MSWORD
Data Use Agreement adobelogo MSWORD



Checklist for IRB Submissions

-Investigators have developed these Research Tracking Forms which we have posted for your convenience
-If you find these forms helpful, use them.
PDF Document Word Document
Research Group Management Checklist adobelogo MSWORD
Subjects Management Checklist adobelogo MSWORD



Miscellaneous Forms PDF Document Word Document
Participant Payment Disclosure Form adobelogo MSWORD

 

Confidentiality Agreement PDF Document Word Document
Confidentiality Agreement Form PDF MSWORD

 

Integrity

Regulatory

Quality Assurance

Contact Information

Human Research Protection Program
Ernest C. Young Hall
10th Floor, Room 1032
155 S. Grant Street
West Lafayette, IN
47907-2114