UAB IRB Reliance Agreement

DocuSign Envelope ID: 561684DA-CFFD-410F-BB7D-1F342CA4EBE5

Purpose of Form: If not using the SMART IRB Online Reliance System to coordinate and

document study-specific reliance arrangements, institutions may use this template to
document the Reviewing IRB and Relying Institutions for a study.

Acknowledgement of Site Agreement to Cede IRB Review
and Reviewing IRB to Provide Oversight
This form documents that:
1) The Columbia University Medical Center (CUMC) IRB will serve as the Reviewing IRB for University of Alabama
at Birmingham for the study noted below;
and
2) University of Alabama at Birmingham has agreed to cede IRB review to the CUMC IRB for the study noted
below.
Study Title:

mChoice: Improving PrEP Uptake and Adherence among Minority MSM
through Tailored Provider Training and Adherence Assistance in Two
High Priority Settings

CUMC Principal Investigator:

Rebecca Schnall, PhD

CUMC RASCAL Study Number:

AAAT8812

Sponsor or Funding Agency (if any):

Centers for Disease Control (CDC)

Relying Institution Principal Investigator:

Mirjam-Colette Kempf, PhD, MPH

Relying Institution Study Number (if any):

IRB-300008573

IRB review will be ceded under the SMART IRB Master Common Reciprocal Institutional Review Board Authorization
Agreement Version 1.
Questions about the IRB review process or study status should be directed to Tasha Isles Smith, MA, MPH, at
[email protected]
Acknowledged by:
CUMC IRB Designee Signature:

Date:
2/18/2023 | 12:26:29 AM GMT

__________________________________________________

Print Name: Andrew B. Lassman, MD
Title: Associate Dean of Clinical Research Compliance
University of Alabama at Birmingham Designee Signature:

Date:

__________________________________________________

Print Name: Vanessa M. Champigny, MBA, CIP
Title: Assistant Director, UAB Office of the IRB

www.smartirb.org

Funded by the NIH National Center for Advancing Translational Sciences through its Clinical and Translational Science Awards
Program, through grant number 3UL1TR002541-01S1.

SMART IRB encourages use and distribution of this content. If you extract any language, please cite SMART IRB as follows,
obtained from [doc name] as part of SMART IRB, which is funded by the NIH National Center for Advancing Translational Sciences through its
Clinical and Translational Science Awards Program, grant number 3UL1TR002541-