INSTITUTIONAL REVIEW BOARD (IRB) AUTHORIZATION AGREEMENT BETWEEN THE GEORGE

13 UTICA COLLEGE INSTITUTIONAL REVIEW BOARD RESEARCH
ERASMUS INSTITUTIONAL KEY DATA NORWEGIAN UNIVERSITY OF
INSTITUTIONAL REVIEW BOARD AUTHORIZATION FOR USE OF PROTECTED

INSTITUTIONAL REVIEW BOARD HIPAA “MINIMUM NECESSARY” STANDARD PER
INSTITUTIONAL REVIEW BOARD HIPAA LIMITED DATA SET OFFICE
04-17-_external_institutional_review_boards_reliance_agreements_for_multi-site_research

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 between

The George Washington University and

Name of Institution or Organization Providing IRB Review (Institution A): The George Washington University

Federalwide Assurance (FWA) #: 00005945

IRB Registration #s: 00000169 and 00004089

Contact: [email protected], 202-994-2715

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

FWA #:

Name of “Institution B” Principal Investigator:

Signature of “Institution B” Principal Investigator: Date:

The Officials signing below agree that (Institution B) may rely on The George Washington University IRB for review and continuing oversight of its human subjects research described below:

This agreement is limited to the following specific protocol at Institution A:

IRB Protocol Number:

Name of Research Project:

Sponsor or Funding Agency:

Award Number:

Name of GWU Principal Investigator:

Signature of GWU Principal Investigator: Date:

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 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 A): Date:

Sheila R. Garrity, JD, MPH, MBA, Associate Vice President, Research Integrity

Signature of Signatory Official (Institution B): Date:

Print Full Name:  

Institutional Title:  

Template IAA_GWU Lead_2015

V. 08OCT15

13 FORM IACUC 00105 AMERICAN UNIVERSITY OF BEIRUT INSTITUTIONAL
16 DFIDFEDERATION INSTITUTIONAL STRATEGIC PARTNERSHIP III DG ECHO
19 INSTITUTIONAL ORDER INTERACTION ORDER AND SOCIAL ORDER ADMINISTERING

Tags: (irb) authorization, authorization, review, institutional, agreement, between, board, (irb), george