Attachment 6B NIH approval

Amendment
Protocol Number:

Reference Number:

11CN206-A

Principal Investigator: Qing Lan 240.276.7171

338357

[email protected]

(NIH Employee Name, Institute/Branch, Telephone and e-mail)

Protocol Title:

A multi-center international hospital-based case-control study of lymphoma in Asia (AsiaLymph)

SIGNATURES
Principal Investigator (*):
Qing Lan - applied signature on 07/11/2014 8:17 AM EDT
Accountable Investigator:
PI is the Accountable Investigator
Branch Chief/CC Department Head (**):
Debra Silverman - applied signature on 07/11/2014 9:25 AM EDT
Medical Advisory Investigator (if applicable):
N/A
Lead Associate Investigator signature:
N/A
Referral Contact signatures:
Qing Lan 240.276.7171

[email protected]

Associate Investigators signatures:
N/A
For Institute/Center Scientific Review Committee:
N/A
Other IC Clinical Director signatures:
N/A
APPROVALS
IRB Chair:
Catherine Schairer - applied signature on 07/11/2014 11:06 AM EDT
Clinical Director:
William Dahut - applied signature on 07/14/2014 9:03 AM EDT
CONCURRENCE
OPS Protocol Specialist:

Tiffany Johnson
Signature

7/21/2014
Print Name

Date

* Signature signifies that investigators on this protocol have been informed that the collection and use of personally identifiable information at
the NIH are maintained in a system of record governed under provisions of the Privacy Act of 1974. The information provided is mandatory for
employees of the NIH to perform their assigned duties as related to the administration and reporting of intramural research protocols and
used solely for those purposes. Questions may be addressed to the Protrak System Owner.
** I have reviewed this research project and considered the NIH Policy for Inclusion of Women and Minorities in Clinical Research. Taking into
account the overall impact that the project could have on the research field involved, I feel the current plans adequately includes both sex/
gender, minorities, children, and special populations, as appropriate. The current enrollment is in line with the planned enrollment report for
inclusion of individuals on the basis of their sex/gender, race, and ethnicity and is appropriate and of scientific and technical merit.

IRB Meeting Date:
DEC Clearance Date:

Expedited
N/A

Protocol Version Date: 07/11/2014