Fillable Research Review And Approval Form (Page 2 of 4) in pdf

Research Review and Approval

Form Part A: Decision Making Tool

Does the project fall under the category of human

subjects research?

Directions: Provide a project summary and complete the questionnaire, in order to help you determine if your research project requires an

application submission to the IRB. When you have completed Part A submit this form to the appropriate IRB member. The IRB website has a list

of IRB member, and the unit of the University and State Library that they service.

Summary of Project: Submit a one page summary (or abstract) of your project with the following form. Include the following information in

the summary: who are the participants, what you will do, when the project will occur, where it will occur, and what you hope to determine by

completing the research.

Questionnaire: Complete the following questionnaire to determine if the proposed project could be considered human subjects research.

Human subjects are called participants in a research study.

Will the participants in the project be identifiable through records, responses, or personal information to anyone else but the researcher?

YES

Could participant’s reputations, financial standing, or legal standing be at risk if their responses were identified?

YES

Does the project ask questions about or explore sensitive aspects of participant’s lives, such as illegal conduct, drug and alcohol use, mental health

issues, abuse, or sexual issues?

YES

Does the research involve the taking of any images or audio of the participants, via any means, camera, audio, cell phone, etc.?

YES

Are participants voluntarily participating, and are they free to withdraw at any time?

YES

Does the project target any of the following types of participants, who are considered vulnerable populations?

Children who are under the age of 18

Physically challenged

Economically disadvantaged

Legally incompetent adults

Pregnant women

Terminally ill

Cognitively or mentally impaired individuals

Traumatized or comatose

Prisoners

Does the project involve any of the following activities?

Administration of drugs

Taking tissue samples

Drawing blood

Administration of alcohol

Use of medical devices

Giving injections

Administration of nutritional supplements

Invasive procedures

Is any of the data to be collected online with identifiable email addresses or electronic signatures?

YES

Will any identifying information that may link the data to individual participants be included in your research records?

YES

Does the research involve the study of existing databases where the individual participant data is identifiable?

YES

A y s answer to any of the above questions places the project in the category of human subject research. A submission of the research proposal

for IRB review is required. If a y s is answered to any of the above questions, proceed to Part B: Application for IRB Approval.

IRB Member submitted to: __________________________________________________________ Date Reviewed: _______________

The project is determined to be:

Research

Not research

IRB member signature: ________________________________________________________________________________________

Communicated to Principal Investigator: Method of communication and date: (IRB member to attach communication)

__________________________________________________________________________________________________________

IRB member to forward electronic copy to IRB when form is completed.

Research Review And Approval Form Page 2

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