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 informed consent doc | Form to apply for waiver or alteration of informed consent. | May 8, 2023 | |
| Request for waiver or alteration of HIPAA authorization doc | Form to apply for waiver or alteration of HIPAA authorization requirements. | December 21, 2018 | |
| Summary information sheet on IRB waiver of alteration of informed consent or HIPAA authorization PDF | Summary information sheet on IRB waiver of alteration of informed consent or HIPAA authorization. | October 20, 2022 | |
| 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. | November 29, 2023 | |
| 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 | |
| Informed consent requirements doc | Informed consent requirements for studies submitted to the IRB. | March 26, 2021 | |
| Informed consent template PDF | Recommended plain-language informed consent form template. | May 11, 2022 | |
| Summary of data covered by HIPAA PDF | A summary of kinds of data covered by HIPAA. | July 2014 | |
| Data security management information sheet PDF | Form to provide information related to data encryption and other security measures. | February 22, 2024 |