Form 18 Application Request to Review Translated Documents

OMB#: 0925 – 0625

Expiry Date: 01/31/2014

NOTIFICATION TO RESPONDENT OF ESTIMATED BURDEN

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0625). Do not return the completed form to this address.

REQUEST TO REVIEW TRANSLATED DOCUMENTS

Complete and submit this form to request CIRB review of translated documents. If you have any questions regarding the completion of this request, please contact the CIRB Helpdesk at 888-657-3711 or [email protected].

In order for the CIRB to review and approve translated documents, the English language version of the document must already have CIRB approval.

STUDY NUMBER:      

STUDY TITLE:      

PROTOCOL VERSION DATE:      

This request should be based on the current CIRB-approved Protocol Version Date.

STUDY CHAIR:      

The Study Chair requests CIRB review and approval of the following translated documents. Please check all that apply:

Informed Consent Document (ICD). If submitting multiple ICDs, please list titles below:

1.      

2.      

Other documents (please list below):

1.      

2.      

Additional Required Documents. Check off below when document is attached:

CIRB-approved English language document(s) corresponding to the translated document

Translated version(s) of the CIRB-approved English language document

Translator’s Certificate(s) of Accuracy or equivalent document(s)

Application Version dated 07/012/11 Page 1 of 1