Institutional Review Board (IRB) Authorization Agreement

0990-0278_IRB Authorization Agreement for the Federalwide Assurance _Supplemental Sample.rtf

Federalwide Assurance (FWA)

Institutional Review Board (IRB) Authorization Agreement

OMB: 0990-0278

Document [rtf]
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Version Date: 02/10/2014


Sample text for an Institution with a Federalwide Assurance (FWA) to rely on the IRB/IEC of another institution (institutions may use this sample as a guide to develop their own agreement).


Institutional Review Board (IRB) Authorization Agreement


Name of Institution or Organization Providing IRB Review (Institution/Organization A):

___________________________________________________________________________________


IRB Registration #: ________________ Federalwide Assurance (FWA) #, if any: _________________



Name of Institution Relying on the Designated IRB (Institution B):

___________________________________________________________________________________


FWA #: _____________________


The Officials signing below agree that (name of Institution B) may rely on the designated IRB for review and continuing oversight of its human subjects research described below: (check one)


(___) This agreement applies to all human subjects research covered by Institution B’s FWA.


(___) This agreement is limited to the following specific protocol(s):


Name of Research Project:________________________________________________________

Name of Principal Investigator:_____________________________________________________

Sponsor or Funding Agency: ________________ Award Number, if any: ___________________


(___) Other (describe):________________________________________________________________


The review performed by the designated IRB will meet the human subject protection requirements of Institution B’s OHRP-approved FWA. The IRB at Institution/Organization A will follow written procedures for reporting its findings and actions to appropriate officials at Institution B. Relevant minutes of IRB meetings will be made available to Institution B upon request. Institution B remains responsible for ensuring compliance with the IRB’s determinations and with the Terms of its OHRP-approved FWA. This document must be kept on file by both parties and provided to OHRP upon request.


Signature of Signatory Official (Institution/Organization A):

________________________________________ Date: ___________


Print Full Name: ________________________________ Institutional Title: _____________________



Signature of Signatory Official (Institution B):

________________________________________ Date: ___________


Print Full Name: ________________________________ Institutional Title: _____________________



File Typetext/rtf
File TitleSample text for an Institution with a Federalwide Assurance (FWA) to rely on the IRB/IEC of another institution (institutions ma
Authorwaldenj
Last Modified ByFunn, Sherrette (OS/ASA/OCIO/OEA)
File Modified2014-05-21
File Created2014-05-21

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