Forms

New Studies for Upstate IRB Review:

• Application (text alt)
  • Page 1a (text alt) (use for additional study team members)
• IND Exemption Checklist (text alt)
• Volunteer Recruitment (text alt)

Approved/Ongoing Studies:

• Amendment Request (text alt)
• Local Adverse Event (text alt)
• Continuing Review Report (text alt)
  • Continuing Review Guidelines (text alt)
  • 5-Year Renewal Guidelines (text alt)

Additional Forms:

• Acknowledgement of Receipt (text alt)
• Termination Request (text alt)
• Individual Investigator Agreement (text alt)
• Emergency Use
• Pathology Department, Request for Tissue for Research Purposes
• University Hospital, Patient Data Request text

HIPAA Related Forms

• De-Identification (text alt)
• Limited Data Set (text alt)
• Waiver of Authorization (text alt)
• Research on Decedent's Information Request text
• University Hospital, Review Preparatory to Research Request text
• University Hospital, Voluntary Faculty Request to Conduct Research which Requires the Use / Disclosure of IIHI text
• Notice of Privacy Practices Website

NCI Central IRB (CIRB) Approved Studies:

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