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Forms & Instructions: To Submit a Request to the DSHS IRB#1

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Prior to Submitting an Application

The first step in submitting an application is to contact the appropriate DSHS Program Contact. (Alphabetical list of Programs and Contacts).

Once you have gotten in touch with the Program Contact, discuss what you need and determine the best way to present your request. Complete the latest version of the application, which can be downloaded (below). Include any additional materials. Make the appropriate number of copies. Sign the original, and send the submission to the Program Contact for his/her signature. The Program Contact will forward the submission to the IRB Office after signing the application.

Submission Deadline

See the Meeting Schedule & Submission Deadline page.  Applications received on or after the submission deadline, that cannot be exempted or examined using an expedited review procedure, will be scheduled for a full board review in the following month.  Send your complete submission, original and copies, to the program contact listed on the first page of the application.  The program contact will need time to review and sign the application and forward the submission to the IRB Office before the submission deadline.

An exemption or an expedited review can be requested.


 

Instructions

Investigator/Data Requestor must submit signed originals, through the Program Contact.
                                               Electronic and FAX submission will not be accepted.

  • For first-time submissions, submit one original and 16 copies (all collated, double-sided, and no staples) of the Application and all additional forms.  The program should keep one copy for its records.
  • For renewals and amendments, except for requests for Hospital Discharge/Outpatient Data and Vital Statistics Data/Certificates, submit one original and one copy (all collated, double-sided, and no staples) of the Application and all additional forms.  The program should keep the copy for its records.
  • For renewals and amendments concerning requests for Hospital Discharge/Outpatient Data and Vital Statistics Data/Certificates, submit one original and 16 copies (all collated, double-sided, and no staples) of the Application and all additional forms.  The program should keep one copy for its records.
  • To request an expedited review or an exemption, submit one original and one copy (for the program).  If your request cannot be expedited or exempted, you will be asked to submit additional copies.  NOTE:  Requests for Hospital Discharge/Outpatient Data and Vital Statistics Data/Certificates cannot be expedited or exempted.
  • Use the appropriate checklist (below the FORMS) to ensure you are submitting all the needed paperwork.

FORMS (NOTE:  WORD forms expand to fit text; PDF forms do not expand)

WORD

PDF

Application   (Required with every submission)

IRB Application - WORD Version

IRB Application - PDF Version 296 kb

New Submission Detail

New Submission Detail Form - WORD Version

New Submission Detail Form - PDF Version 209 kb

Renewal Submission Status Report

Renewal Submission Status Report form - WORD Version

Renewal Submission Status Report form - PDF Version 188 kb

Data Request Application (Check with appropriate DSHS Program to see if they have one)

Request for Exemption from Review of Research (Use to request a Public Health Practice exemption)
(NOTE:  Federal regulations do not allow research involving prisoners, fetuses, pregnant women, or human in vitro fertilization to be exempted.  Also, requests for Hospital Discharge/Outpatient Data and Vital Statistics Data/Certificates cannot be exempted.

Exemption Request form - WORD Version

Exemption Request form - PDF Version 223 kb

Request for Expedited Review of Research
(NOTE:  In IRB terminology, an “expedited review” means a review of proposed research by the IRB Chair or a designated voting member or group of voting members, rather than by the entire IRB.  Federal rules permit expedited review for certain kinds of research involving no more than minimal risk and for minor changes in approved research.  In the context of research review by an IRB, expedited does not necessarily mean quick or fast.  Also, requests for Hospital Discharge/Outpatient Data and Vital Statistics Data/Certificates cannot be expedited.  This includes renewals and amendments.

Expedited Review Request form - WORD Version

Expedited Review Request form - PDF Version 207 kb

Waiver of Informed Consent  (If not submitting consent documents)

Waiver of Informed Consent form - WORD Version

Waiver of Informed Consent form - PDF Version 222 kb

Amendment Request

Amendment Request form - WORD Version

Amendment Request form - PDF Version 217 kb

Final Report (May be e-mailed without an Application)

Final Report form - WORD Version

Final Report form - PDF Version 214 kb

CHECKLISTS

WORD

PDF

Initial Submission

New Submission Checklist - WORD Version

New Submission Checklist - PDF Version 79 kb

Renewal Submission

Renewal Submission Checklist - WORD Version

Renewal Submission Checklist - PDF Version 75 kb

Amendment

Amendment Submission Checklist - WORD Version

Amendment Submission Checklist - PDF Version 74 kb

 
 
 
 
 
 
 
 
 

 


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Last updated March 12, 2014