IRB Application Templates and Samples

IRB Application Package (Includes all of the Documents below)

A Checklist of items required to accompany the IRB application is provided below. For more detailed application instructions click here: IRB Application Instructions

Checklist of items required to accompany completed application form:

1. Complete IRB Application Cover Letter.
2. Complete IRB Application.
3. Documented DON HRPP Ethics Training provided by CITI Link to DON HRPP Training
4. Complete grant proposal/contract (i.e., SOW - externally funded projects).
5. All questionnaires, interview questions, or other materials to be used.
6. Informed consent documents:
   1. Informed Consent Form (written to fully explain the experiment to the participant)
   2. Requested for waiver of written consent (i.e., web survey that is not getting signatures)

Checklist of optional items to accompany application (project dependent)

1. Separate privacy act statements (for video or audio recording)
2. Subject introductory materials
3. Subject recruitment materials
4. Subject advertisement materials
5. Debriefing form (required if project contains any deception)

Sample materials are provided below for your convenience but they should be modified and tailored to fit your experiment.

Components of the IRB Application Package:

• IRB Application Instructions
• IRB Application Cover letter (Sample)
• IRB Application
• IRB Informed Consent (Sample)
• Request for Waiver of Informed Consent
  • Request for Waiver of Informed Consent (Sample)
• Consent Agreement for Audio or Video Recording (Sample)
• IRB Adverse Event Report (Sample) – Provided if an adverse event happens during your experiment
• End of Experiment Report (Sample) – Must be submitted after experiment is complete
  

Please submit signed IRB Applications to Laura Ann Ikner-Price in HA-201B.
All questions and comments concerning the IRB can be emailed to the Institutional Review Board.