Forms

HRRC Menu

All forms are in Word Format

HRRC Data/Specimen Repository Plan Application, Form
If you are planning to establish a Data or Specimen repository for research purposes, complete this form and submit it to the HRRC for review and approval prior to establishing the repository. You should also review the "HRRC Policy: Research Involving data Repositories".

HRRC Application, Form A
Use Form A to submit an initial application for Committee review of a proposed research project.

Continuing Review, Form B
Use Form B to: (1) request a continuing review, (2) request amendments or revisions to an HRRC-approved project, OR (3) report unanticipated problems, adverse events or complaints.

Research Project Closure, Form F
Use Form F to notify the HRRC when your research project is completed.

Report Inquires, Form C
Use Form C to report inquiries, comments and/or concerns from human research subjects, the community, and others.

Individual Investigator Agreement, Form D
Form D provides a permissible mechanism under which an institution holding an Office for Human Research Protections (OHRP)-approved Federalwide Assurance (FWA) (hereafter referred to as the assured institution) may extend - for one or more research protocols - the applicability of its FWA to cover two types of collaborating individual investigators: collaborating independent investigators and collaborating institutional investigators.

Assent Template, Form E
Form E is meant to help investigators in preparing assent forms; the use of this template is not required.

Confidentiality Certificate, Form G
At the discretion of the Chairperson or her/his designee, persons may be permitted to attend/observe HRRC meetings as guests.

Supplement 1
Use Supplement 1 if you are requesting Exempt Review. Be sure to attach this supplemental form to the completed "Application Form A".

Supplement 2
Use Supplement 2 if you are requesting Expedited Review. Be sure to attach this supplemental form to the completed "Application Form A".

Conflict of Interest Disclosure Statement, Form H

Conflict of Interest Disclosure Supplement, Form H Supplement
Use Form H and Form H Supplement to disclose or deny any financial interest(s) in the research project.