Ana G. MéndezUniversity System

Vice Presidency for Planning and Academic Affairs

Associate Vice Presidency for Sponsored Programs and Compliance

Office of Regulatory Compliance

IBC Form 7 IBC Number: ______

Continuing Review / Notice of Transfer or Termination

Continuing Review: If you wish to continue your IBC Registration of biohazardous materials (biological agent, chemical agents, rDNA or rRNA), you must complete this form and submit it to the IBC at least one month prior to the end of the current approved period.

Transfer: If, at any time, you wish to transfer possession of a registered material, complete this form and submit it to the IBC. No transfer of previously registered materials shall occur until IBC approval is obtained.

Termination: If, at any time, you wish to terminate your use or possession of any registered material complete this form and submit it to the IBC. Make sure you complete the form for each previously registered material. No disposal of registered material shall occur until IBC approval is obtained.

  1. Basic Information

  1. Principal Investigator Name:

  1. E-mail:

  1. Phone/ Fax:

  1. Department/School:

  1. AGMUS Institution:

  1. Funding Agency (if applicable):

  1. Project Title:

  1. Laboratory Location:

  1. Type of use:
/ Biological Agent rDNA/ rRNA Hazardous Chemical others
  1. Mentor/ Co-Investigator

  1. Mentor/ Co-investigator’s Name:

  1. E-mail:

  1. Phone/ Fax:

  1. Department/School:

  1. AGMUS Institution:

  1. Protocol Status

  1. Indicate the status of this project:
/ Active - project on-going
Inactive - anticipated start date:
Completed - no further activities will be performed under this protocol.
  1. Project/ Protocol Basic information

Please list the biohazardous agent(s) (biological, chemical or rDNA/rRNA) used for this research. Be specific to include species name, stain designation, cell line source/designation, and other information about the agent to help in this review process.
  1. Type of request

Request for Continuation, Notice of Termination or Transfer (please choose one only):
I request continued IBC approval of my use/possession of the previously registered material described above.
I request termination of IBC approval. Attach is a separate sheet describing when and how the biohazardous material(s) identified above will be disposed off.
I request to transfer possession of theregistered material described above to: ______. If the transferee is an AGMUS faculty member or employee, the transferee must complete and submit the appropriate IBC Registration Forms (IBC Form 1 or Form 2) to the IBC and receive approval before transfer of the material can occur. Furthermore, the transferee shall have his/her laboratory registered with the IBC (Form 5), before transfer of any material can occur. If the transfer is to another institution or individual outside AGMUS, contact the Office of Regulatory Compliance.
If requesting continued IBC approval, indicate whether:
1. The Principal Investigator will change / Yes* / No
2. The Risk Group (RG) will change? / Yes* / No
3. The Biosafety Level (BSL) will change? / Yes* / No
4. The type or amount of the registered material will change? / Yes* / No
5. The registered material will be moved to another laboratory? / Yes* / No
6. The use of the registered material will change? / Yes * / No
7. The identity of the registered biological agent will change?
If yes, explain: / Yes * / No

*If the answer to any of the above questions (1–7) is yes, you must submit an IBC Changes Form (IBC Form 8) to the IBC for approval before making any of these changes. Furthermore, if the registered material will be moved to another laboratory, the Principal Investigator or Director of the laboratory in question should complete and send IBC Form 5 for the IBC approval. No registered materials should be moved to unregistered laboratories. Once the material is moved, the Principal Investigator of the laboratory shall register the material under his/her name.

  1. Adverse/ unanticipated Events

  1. Have any adverse events occurred since registration approval or last request for continuing approval?
/ Yes* No
*If yes, was an adverse Event Report Form (IBC Form 4) submitted to the IBC? / Yes No
  1. Certification

I certify that the above information accurately describes the current status of the registered material that was previously approved by the IBC.

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Signature of Principal Investigator(mm/dd/yy)

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Signature of Dean(mm/dd/yy)

Submit this completed form to the AGMUS’ Office of Regulatory Compliance.

IBC Use Only

Date Recieved: /// (mm/dd/yy)

Continuation Approved Transfer Approved Termination Approved

Continuation Disapproved Transfer Disapproved

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IBC Chair Signature(mm/dd/yy)

IBC-signed copy returned to Registrant and/or Transferee.

IBC_Continuing_Review_Notice_of_Termination_071AGMUS IBC-07

Revised (7/2015)