Reviewing Institution. CDC IRB CDC Institutional Official for Human Subjects Protections 0000 Xxxxxxx Xx NE MS D-73 Atlanta GA 30333 404-639-7270 xxxx@xxx.xxx (e-mail) Relying Institution: Date Signed Official Title and Contact Information IRB Authorization Agreement: Relying Institution on CDC IRB (FDA) CDC IRB Responsibilities (this list is not exhaustive; please see applicable human subjects regulations):
Reviewing Institution. 1. Financial agreements (for review costs) ☒ OPTION 1 – Reviewing IRB/Institution will not charge Relying Institution(s) for costs of review The Relying Institution(s) will not be responsible for financial support of the costs of review of the identified study(ies). The Reviewing IRB may charge the sponsor or other third parties for those costs. ☐ OPTION 2 – Reviewing IRB/Institution will charge the Relying Institution(s) for costs of review The Reviewing IRB and the Relying Institution(s) will enter a separate agreement or agreements under which the Relying Institution(s) will provide financial support to the Reviewing IRB for the costs of review of the identified study(ies).
Reviewing Institution. Information Check here if this request is to designate a Harvard IRB as the Reviewing Institution, and skip to question #3: a. Name of Institution: b. Federalwide Assurance (FWA)* number: c. IRB Registration* number: d. IRB Contact Name/Email/Phone Number: e. Signatory Official Name: f. Signatory Official Contact Address/Phone Number: *Federalwide Assurance and IRB Registration numbers can be found at xxxx://xxxx.xxx.xxx.xxx/search/
