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Forms for studies submitted to the Institutional Review Board (IRB)

The Department of Public Health participates in research to improve services and care for the public. Research studies that involve human subjects must be reviewed by the Institutional Review Board (IRB) before and during the study.

Some of these forms may be used in the process of submitting a study to the Institutional Review Board (IRB). Others may be used while conducting studies that have been approved by the IRB.

Name Description Released Format
IRB proposal submission application docx Primary application for submitting a study to the IRB. February 22, 2024
Application to use City data for research purposes doc This form and supporting documents must be submitted with each IRB Application from an external researcher that proposes to use City owned data. December 21, 2018
Conflict of interest form doc In reviewing proposals, IRB members are required to assure that research study participants are protected from any issue that may arise from a conflict of interest on the part of the investigator. November 7, 2018
Department/division manager approval statement doc Form to indicate support by involved department/division manager. November 21, 2023
Request for waiver or alteration of HIPAA authorization doc Form to apply for waiver or alteration of HIPAA authorization requirements. December 21, 2018
Continuing review of approved studies doc Form to provide updates on an ongoing study. October 6, 2021
Revisions to approved study form doc Form to submit revisions of an approved study to the IRB. July 8, 2024
Closure report doc A closure report should be submitted at the conclusion or termination of the study, and prior to the IRB approval expiration date. November 7, 2019
IRB exempt application doc Form to request exemption from an IRB review. February 1, 2023
Summary of data covered by HIPAA PDF A summary of kinds of data covered by HIPAA. July 2014
Data security management information sheet docx Form to provide information related to data encryption and other security measures. May 3, 2024