Download:
pdf |
pdfNotice of Exemption from Federal Regulations
for the Protection of Human Subjects Form
IRB 0840G32713.XX.X3
Rev 3.0
Battelle Institutional Review Board
Lisa John / Stephanie Peak / Andrew Davis
Principal Investigator/Project Manager /
Project Director:
National Tobacco Education Campaign – (NTEC / TIPS Campaign) Rough Cut Testing with
Proposal/Project Title:
Adults Who Smoke Cigarettes
PlowShare Group (Lead Organization) /
Client/Funding Agency:
Centers for Disease Control and Prevention (Funding Agency)
IRB 0840-G32713.XX.X3 Rev 3.0
IRB No:
OPP Number /
Contract No:
OPP226786 / CON00032713 –
No change planned at this time
Date of Submission
to IRB:
Project
Code:
Dated 9/24/2024; received by
IRB on 9/30/2024
G32713.XX.X3.303F.000001
(Formerly G32713.XX.X1.0001.OY1F10)
Subcontract to Battelle from:
N/A
Subcontract from Battelle to:
Sago (Adnan Habib; PM)
Level of Review:
Exemption from Regulation:
This research activity poses a
minimal risk to human subjects
Basis for Ruling
This is an Approval of
Amendments, including the
addition of a new study survey
expected to engage 10,800
respondents and the addition of
new study personnel (personnel
will not have access to identifying
information) Survey to include
minor edits from historic survey,
including OMB-updated categories
for demographic categories. No
planned deviation from previously
established panels.
Issued as Rev 3.0
Exemption per 45 CFR 46.104(b)(2)(i)
(2) Research that only includes interactions involving educational tests (cognitive,
diagnostic, aptitude, achievement), survey procedures, interview procedures, or
observation of public behavior (including visual or auditory recording) if at least
one of the following criteria is met:
(i) The information obtained is recorded by the investigator in such a manner
that the identity of the human subjects cannot readily be ascertained, directly
or through identifiers linked to the subjects;
Amendment to include a new survey to test 12 short ads. Survey research to
assess efficacy of proposed advertisements to promote cessation of use for
nicotine-containing products. This ruling applies to the scope(s) of work for
Battelle (data analysis/reporting), Plowshare (Lead Investigator) and for the Sago
organization and its partner panels (recruiting and data collection).
Perceived minimal risk to human subjects. Subject population will be legal adults,
English speakers, who have voluntarily chosen to use tobacco products and/or
other nicotine-containing products AND who have voluntarily chosen to take part
in focus groups/surveys/interviews administered participate in surveys/in-depth
interviews via the Sago online survey/questionnaire web-based data collection(s).
Respondents are self-described U.S. residents who have voluntarily agreed to the
terms of Sago’s and its associated vendor/panels’ published Privacy/Confidentiality
Policies. Data collection results will be maintained by Sago in accordance with
their established privacy policies and will be provided to Battelle (and, hence, to
Plowshare/CDC) with no participant’s identifiable, private information. All
results/project outputs will be reported in aggregate and there will be no
association between Sago-held information and project outputs. Respondents’
demographic information may include sensitive information but is voluntarily
disclosed and all privacy and data confidentiality measures are adequate. Small
remuneration offered for participation. The respondent’s agreement to participate
will be documented via the study recruiting screener.
While this study qualifies for a formal EXEMPTION from federal regulations (2018 Common Rule at 45 CFR 46, Subpart A)
for the protection of human subjects, IRB 0840-G32713.XX.X3 Rev 3.0 will continue under Battelle IRB oversight.
Oversight requirements include:
•
The IRB will request a status update of this project at least once every 365 days.
•
Events or other conditions potentially resulting in a loss of human subjects’ privacy or lapse of data confidentiality
must be reported to the IRB.
•
Any audit, inspection or inquiry by a federal agency must be reported to the IRB.
•
If changes, amendments, or addenda to the Work Plan are anticipated, advise the IRB. If the IRB determines
that an application for amendment is warranted, submit the application and supporting documentation to the
IRB before instituting Work Plan changes.
Approved on behalf of Battelle and the Battelle Institutional Review Board
30 September 2024
Human Protections Administrator
Title
Gary M. Sapp, MS, CIP, CIM
Name
Signature
Date
Certificate Of Completion
Envelope Id: EF2D6BEB2B7144169C92A4C09F9045E2
Status: Completed
Subject: Complete with Docusign: NoticeofExemption IRB 0840 Rev 3.0 September 2024.docx
Source Envelope:
Document Pages: 1
Signatures: 1
Envelope Originator:
Certificate Pages: 5
Initials: 0
Gary Sapp
AutoNav: Enabled
505 King Ave.
EnvelopeId Stamping: Disabled
Columbus, OH 43201
Time Zone: (UTC-05:00) Eastern Time (US & Canada)
[email protected]
IP Address: 131.167.254.200
Record Tracking
Status: Original
9/30/2024 2:53:32 PM
Holder: Gary Sapp
Location: DocuSign
[email protected]
Security Appliance Status: Connected
Pool: FedRamp
Storage Appliance Status: Connected
Pool: Battelle CFR Part 11 Compliant
Signer Events
Signature
Location: DocuSign
Timestamp
Gary Sapp
Sent: 9/30/2024 2:54:15 PM
[email protected]
Viewed: 9/30/2024 2:54:33 PM
Security Level: Email, Account Authentication
(Required), Login with SSO
Signed: 9/30/2024 2:54:59 PM
Signature Adoption: Pre-selected Style
Signature ID:
E93C6571-6C4D-46B0-AA1D-C994695C1FDA
Using IP Address: 131.167.254.200
With Signing Authentication via DocuSign password
With Signing Reasons (on each tab):
I approve this document
Electronic Record and Signature Disclosure:
Accepted: 2/14/2023 2:56:09 PM
ID: 2df30876-5bd2-484f-8c75-c2553b610406
In Person Signer Events
Signature
Timestamp
Editor Delivery Events
Status
Timestamp
Agent Delivery Events
Status
Timestamp
Intermediary Delivery Events
Status
Timestamp
Certified Delivery Events
Status
Timestamp
Carbon Copy Events
Status
Timestamp
Witness Events
Signature
Timestamp
Notary Events
Signature
Timestamp
Envelope Summary Events
Status
Timestamps
Envelope Sent
Hashed/Encrypted
9/30/2024 2:54:15 PM
Certified Delivered
Security Checked
9/30/2024 2:54:33 PM
Signing Complete
Security Checked
9/30/2024 2:54:59 PM
Completed
Security Checked
9/30/2024 2:54:59 PM
Payment Events
Status
Electronic Record and Signature Disclosure
Timestamps
Electronic Record and Signature Disclosure created on: 8/11/2021 2:41:11 PM
Parties agreed to: Gary Sapp
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, Battelle CFR Part 11 (we, us or Company) may be required by law to provide
to you certain written notices or disclosures. Described below are the terms and conditions for
providing to you such notices and disclosures electronically through the DocuSign system.
Please read the information below carefully and thoroughly, and if you can access this
information electronically to your satisfaction and agree to this Electronic Record and Signature
Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I agree to
use electronic records and signatures’ before clicking ‘CONTINUE’ within the DocuSign
system.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. You will have the ability to download and print documents we send
to you through the DocuSign system during and immediately after the signing session and, if you
elect to create a DocuSign account, you may access the documents for a limited period of time
(usually 30 days) after such documents are first sent to you. After such time, if you wish for us to
send you paper copies of any such documents from our office to you, you will be charged a
$0.00 per-page fee. You may request delivery of such paper copies from us by following the
procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to
receive required notices and consents electronically from us or to sign electronically documents
from us.
All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through the DocuSign system all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or made
available to you during the course of our relationship with you. To reduce the chance of you
inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.
How to contact Battelle CFR Part 11:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: [email protected]
To advise Battelle CFR Part 11 of your new email address
To let us know of a change in your email address where we should send notices and disclosures
electronically to you, you must send an email message to us at [email protected] and
in the body of such request you must state: your previous email address, your new email
address. We do not require any other information from you to change your email address.
If you created a DocuSign account, you may update it with your new email address through your
account preferences.
To request paper copies from Battelle CFR Part 11
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an email to [email protected] and in
the body of such request you must state your email address, full name, mailing address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with Battelle CFR Part 11
To inform us that you no longer wish to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your signing session, and on the subsequent page,
select the check-box indicating you wish to withdraw your consent, or you may;
ii. send us an email to [email protected] and in the body of such request you must
state your email, full name, mailing address, and telephone number. We do not need any other
information from you to withdraw consent.. The consequences of your withdrawing consent for
online documents will be that transactions may take a longer time to process..
Required hardware and software
The minimum system requirements for using the DocuSign system may change over time. The
current system requirements are found here: https://support.docusign.com/guides/signer-guidesigning-system-requirements.
Acknowledging your access and consent to receive and sign documents electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please confirm that you have
read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for
your future reference and access; or (ii) that you are able to email this ERSD to an email address
where you will be able to print on paper or save it for your future reference and access. Further,
if you consent to receiving notices and disclosures exclusively in electronic format as described
herein, then select the check-box next to ‘I agree to use electronic records and signatures’ before
clicking ‘CONTINUE’ within the DocuSign system.
By selecting the check-box next to ‘I agree to use electronic records and signatures’, you confirm
that:
You can access and read this Electronic Record and Signature Disclosure; and
You can print on paper this Electronic Record and Signature Disclosure, or save or send
this Electronic Record and Disclosure to a location where you can print it, for future
reference and access; and
Until or unless you notify Battelle CFR Part 11 as described above, you consent to
receive exclusively through electronic means all notices, disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
available to you by Battelle CFR Part 11 during the course of your relationship with
Battelle CFR Part 11.
File Type | application/pdf |
File Modified | 2024-09-30 |
File Created | 2024-09-30 |