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IRRB Submission Forms

Application to Perform Human Subjects’ Research
Submission application for all new research protocols

Application for Research Involving Children and Minors
Submission application for all research studies involving children and minors

Application for Research Involving Pregnant Women, Fetuses, and Neonates
Submission application for all research studies involving pregnant women, fetuses, and neonates.

Application for Central AGMC Peer Review
To request clinical and scientific review of investigator-initiated human subjects research proposals.

Confidential Information Acknowledgement Form
Investigator receipt of confidential information acknowledgement form.

Conflict of Interest Disclosure Form
Investigator Conflict of Interest disclosure form.

Request For Amendment Form
Submit when requesting a change in study personnel, protocol, or informed consent/assent.

Continuing Review Interim Report Form
Submit for continuing/interim review of human subjects’ research.

Unanticipated Adverse Event Reporting Form
Submit when reporting an unanticipated problem and/or serious adverse event.

Notification of Study Closure Form
Submit when all research activity has been completed or remaining study activity is limited to data analysis of de-identified data.

IRB IEC Collaborative Agreement Form
Submit for multi-site study protocols when AGHS is not the lead site in order to designate the IRB of record for the research study.

Quality Assurance or Improvement Checklist Form
Use to determine if proposal is QI/QA or research.

Limited Data Set Request Form
Submit when a non-AGHS investigator is requesting de-identified personal health information.

Request for Review of PHI Preparatory to Research Form
Submit when requesting to review personal health information for preparation of a research protocol.

Date Updated: 06-OCT-2015

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