Forms

New Studies for Upstate IRB Review:

• Application
  • Additional Study Team Page (use to add additional study team members, including responsibility for obtaining informed consent)
  • Pharmacy Worksheet
• IND Exemption Checklist
• Volunteer Recruitment
• Individual Investigator Agreement

Approved/Ongoing Studies:

• Amendment Request
• Report of Unanticipated Problems & Adverse Events
• Continuing Review Report
  • Continuing Review Guidelines  
  • 5-Year Renewal Guidelines  
• Acknowledgement of Receipt
• Termination Request

Additional Forms:

• Emergency Use
• Pathology Department, Request for Tissue for Research Purposes
• University Hospital, Patient Data Request  

HIPAA Related Forms:

• De-Identification
• Limited Data Set
• Waiver of Authorization
• Accounting for Research Disclosures
• Accounting for Research Disclosures (Modified- 50 subjects or more)
• Research on Decedent's Information Request
• University Hospital, Review Preparatory to Research Request  
• University Hospital, Voluntary Faculty Request to Conduct Research which Requires the Use / Disclosure of IIHI 
• SUNY Upstate Notice of Privacy Practices Website

NCI Central IRB (CIRB) Approved Studies:

• Local Application (*use only for cooperative group NCI CIRB studies*)
• Progress Report
• Study Closure Information