San Diego State University IRB Reliance Agreement

DocuSign Envelope ID: 24EE502D-2B8E-4888-A418-C16976371B19

FORM: IRB Reliance Agreement

wcg IRB

Document No.:

Edition No.:

001.2

HRP-235

Effective Date:

21 Jun 2022

Page:

Page 1 of 3

Complete this form when a local IRB has jurisdiction over this research site.
You must submit a typed version of this form (except for the signature block) to prevent errors and delays due to
legibility problems.
Blank & incomplete answers will result in delayed reviews
If you have questions about the use of this form, please contact WCG IRB at 855-818-2289 or email clientcare(a)_wcciirb.com
Relying Organization:
Name:
FWA#:

San Diego State University IRB
00003782 (if organization has an FWA)

Contact Information for Relying Organization:
Name:
Title:

Anne Dodge-Schwanz
Lead IRB Analyst

Address 1:

5500 Campanile Drive

Address 2:

MC 1933

City:
Zip/Postal Code:
Phone:

State/Province:

San Diego

Country:

92182

Email:

619-594-6622

CA
United States
[email protected]

□ This agreement covers all human subjects research conducted by this site (otherwise complete the "Research Protocol” and “Principal
Investigator” sections below)
Research Protocol:
Protocol #:
Protocol Title:

None
Understanding HIV/STD Risk and Enhancing PrEP Implementation Messaging in a Diverse
Community-Based Sample of Gay, Bisexual, and Other Men Who Have Sex with Men in a
Transformational Era (MIC-DROP)

Sponsor Name:

Centers for Disease Control and Prevention

IRB Tracking #:

20225896 (if known)

Principal Investigator:
Name:

Patrick Sullivan, DVM, Ph.D. (Emory), Keith Horvath, Ph.D. (San Diego State University)

The Relying Organization agrees to waive jurisdiction for the IRB review and continuing oversight of the Research Protocol to WCG
IRB (IRB registration number IRB00000533) (“Designated IRB") as allowed under federal regulations. The Principal Investigator is
authorized to conduct the Research Protocol at the Relying Organization.
The review performed by the Designated IRB will meet the human subject protection program requirements of applicable regulatory
agencies. The Designated IRB will follow its written procedures for the review and oversight of the Research Protocol. The Designated
IRB will follow its written procedures for reporting findings and actions, subject complaints, unanticipated problems involving risks to
subjects or others, serious or continuing noncompliance, and suspension or termination to appropriate institutional officials at the
Relying Organization, Relevant minutes of IRB meetings will be made available to the Relying Organization upon request. Relying
Organization remains responsible for ensuring compliance with the Designated IRB’s determinations and with the terms of any

Copyright © 2016 WIRB-Copernicus Group, Inc. All rights reserved.

DocuSign Envelope ID: 24EE502D-2B8E-4888-A418-C16976371B19

FORM: IRB Reliance Agreement

wcg IRB

Document No.:

HRP-235

Edition No.:

001.2

Effective Date:

21 Jun 2022

Page:

Page 2 of 3

agreements between the Relying Organization and applicable regulatory agencies. This document must be kept on file by both parties
and provided to applicable regulatory agencies upon request.

Copyright© 2016 WIRB-Copernicus Group, Inc. All rights reserved.

DocuSign Envelope ID: 24EE502D-2B8E-4888-A418-C16976371B19

FORM: IRB Reliance Agreement

wcg IRB

Document No.:

HRP-235

Edition No.:

001.2

Effective Date:

21 Jun 2022

For Designated IRB

For Relying Organization

Signature

Signature

Sheri Spivey

Printed Name
Regulatory Chair Director

Title
20-Mar-2023 | 11:36 AM EDT

Date

Page:

Page 3 of 3

Natalie Gude, Ph.D.
Printed Name
Assistant Director for Research Support Services
Title
14 March 2023
Date

Copyright © 2016 WIRB-Copernicus Group, Inc. All rights reserved.