IRB Application Templates and Samples

Checklist of items required to accompany completed Initial Review application form:

1. IRB Application.
2. Documented DON HRPP Ethics Training provided by CITI Link to DON HRPP Training for each member of the research team.
3. All questionnaires, interview questions, or other materials to be used.
4. 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)
5. Scientific Review Form.
6. Conflict of Interest Form.

Checklist of optional items to accompany application (project dependent)

1. Separate privacy act statements (for video or audio recording)
2. Subject recruitment materials including advertisements
3. Copy of approved Thesis if part of student research
4. Copy of approved Proposal if part of a funded research project

Components of the IRB Initial Review Application Package:

• IRB Application (13 Feb 2012) Updated
• Sample Informed Consent Forms
  • Standard IRB Informed Consent document (13 Feb 2012) Updated
  • Informed Consent document for an anonymous survey (13 Feb 2012) Updated
  • Informed Consent script for oral consent procedures (25 October 2010)
• Waiver of Documented Consent (13 Feb 2012) Updated
• Waiver or Alteration of Informed Consent (13 Feb 2012) Updated
• Conflict of Interest Disclosure Form (13 Feb 2012) Updated
• Scientific Review Form

Additional Forms:

• Guidance on the use of Online Survey Tools - Survey Monkey approved!
• Protocol Amendment Form
• Continuing Review Report 11/28/11 Updated
• Unanticipated Problems and Serious Adverse Events Form 11/2/11 Updated

Research Completion Requirements:

• End of Experiment Report Updated 4/1/10

Please submit signed IRB Applications to Rikki Panis in HA-283. All questions and comments concerning the IRB can be emailed to rapanis@nps.edu or jkschmid@nps.edu.