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

These forms may be necessary at different points of applying for or conducting a study submitted to the Institutional Review Board (IRB).

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

Name Description Released Format
IRB proposal submission application doc Primary application for submitting a study to the IRB. February 25, 2020
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
Unit manager statement of support doc Form to indicate support by involved unit manager. December 11, 2020
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. November 7, 2018
Revisions to approved study form doc Form to submit revisions of an approved study to the IRB. November 7, 2018
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 12, 2020
Summary of data covered by HIPAA PDF A summary of kinds of data covered by HIPAA. November 7, 2018