IRB Reliance Agreement ApplicationIrb Reliance Agreement • May 8th, 2017
Contract Type FiledMay 8th, 2017Name of Other Institution: Protocol Title: Principal Investigator: Signatory Official: Name: Title: IRB Contact: Name: Address: Phone: Email: Is this institution a “Smart IRB” member?Yes NoSMART IRB is an initiative developed under an award from the National Center for Advancing Translational Sciences (“NCATS”) of the National Institutes of Health (“NIH”) to support single Institutional Review Board (“IRB”) review in facilitation of multi-site human subjects research. Other Institution’sFWA#: Other Institution’sIRB Registration #: Name of Funding Agency:(if research is funded) if none, write: n/a Funding Title: (if applicable)