IRB RELIANCE AGREEMENT REQUEST FORM UVA IRB-HSR to serve as IRB of RecordIrb Reliance Agreement • September 1st, 2023
INSTRUCTIONS AND INFORMATION: Relying Sites should only complete this request form AFTER the UVA IRB-HSR has approved the study locally. One form is to be completed for EACH institution that agrees to rely on the IRB-HSR. Submit the following documents to the Relying site for completion: IRB Reliance Agreement Request Form UVA IRB-HSR to serve as IRB of Record (complete UVA study information) Current approved IRB-HSR protocol, consent(s)/assent(s) (if applicable) Relying Site Local Context Template (Appendix A) -used to add local context to the UVA IRB approved consent/assent documents (TRACK CHANGES MUST BE TURNED ON) Submit the following documents to the UVA IRB to add a relying site Completed IRB Reliance Agreement Request Form UVA IRB-HSR to serve as IRB of Record Completed Modification Request form Tracked copy of the consent/assent which includes the relying site LOCAL CONTEXT information included. NOTE: See Page 6 for complete list of potential documents to be submitted t
IRB Reliance Agreement Request for Chamberlain University IRB to Serve as the Relying IRBIrb Reliance Agreement • September 24th, 2021
Relying IRB’s IRB Registration number and Federal Wide Assurance number (if any): IRB00011037/ IORG0008174 and Federal wide Assurance (FWA) #FWA00021986
IRB Reliance Agreement (Reviewing IRB)Irb Reliance Agreement • March 8th, 2023
This Agreement applies to all Scholarship of Teaching and Learning (SoTL) human subject research conducted by Relying Institution for which Relying Institution submits an application under the “Broad SoTL Protocol” at the Reviewing Institution. This Agreement is effective upon the date of last signature and will remain effective for five (5) years at which time the Agreement may be renewed by both parties.
IRB Reliance Agreement ApplicationIrb Reliance Agreement • June 7th, 2017
Protocol Title: Principal Investigator: PI’s affiliation: Faculty StaffOther Brown Graduate/Medical StudentAdvisor’s name: Will Brown relinquish IRB oversight? Yes No Is Brown conducting human subject research activity?as defined in 45 CFR 46.102 (d) and (f) Yes No Name of Funding Source and Institute Proposal Number:(if research is externally funded) if none,write: n/a Funding Proposal Title: (if applicable) Does Brown issue a sub-award?Yes No If yes, to: Does Brown receive a sub-award?Yes No If yes, from:
IRB Reliance Agreement ApplicationIrb Reliance Agreement • May 8th, 2017
Name 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)
Cooperative IRB Reliance AgreementIrb Reliance Agreement • April 13th, 2018
This agreement applies to all research involving both institutions, except in the circumstances described below and except for oncology-related research for which (1) research subject consent will be obtained and (2) the UW principal investigator is a member of the local Cancer Consortium. Such oncology research must be reviewed by the IRB at the Fred Hutchinson Cancer Research Center.
Instructions for Requesting an IRB Reliance AgreementIrb Reliance Agreement • April 3rd, 2019
An IRB reliance agreement (formerly known as an IRB authorization agreement) is an agreement between two entities allowing the IRB of one entity to assume regulatory oversight of research activities conducted at the other entity for a single or multiple research studies. When an IRB assumes regulatory oversight for another entity, it is referred to as the designated or single IRB. The entity accepting this IRB’s oversight is referred to as the reliant entity or site.
IRB Reliance AgreementIrb Reliance Agreement • January 9th, 2020
This IRB Reliance Agreement is required when an external institution relies on the SUNY Downstate IRB for review and oversight of human research. For instructions for obtaining an FWA and designating the SUNY Downstate IRB on the FWA, see https://www.hhs.gov/ohrp/register-irbs-and-obtain-fwas/fwas/file-a-new-fwa/index.html
IRB Reliance Agreement Between Texas A&M University-Corpus Christi And Institution NameIrb Reliance Agreement • June 17th, 2021 • Texas
THIS IRB RELIANCE AGREEMENT (“Agreement”) is between Texas A&M University-Corpus Christi, a member of The Texas A&M University System, an agency of the State of Texas, having a place of business at 6300 Ocean Drive, Corpus Christi, Texas, hereinafter referred to as (“TAMU-CC”) and Institution Name, having a place of business at address, hereinafter referred to as (“IRB of Record”), each of the aforementioned being referred to individually as the (“Party”) or collectively as the (“Parties”).
