Northwestern University – Institutional Review Board Office
Supplement for Department of Justice (DoJ) Research Funded by the
National Institute of Justice (NIJ)
Please use this form only when:
o The study is under the purview of the Department of Justice (DoJ) and the Research is Funded by the National Institute of Justice (NIJ)
o Department of Justice Regulations 28CFR46: http://www.bop.gov/news/ore28cfr46.pdf
o National Institute of Justice website: http://www.nij.gov/funding/humansubjects/welcome.htm
1. Principal Investigator Name:
2. Project Title:
3. IRB Study Number: STU
4. This form is an attachment to a new study or existing study (select one)
Instructions:
· Handwritten or incomplete forms will not be accepted
· Complete all applicable sections of this form and do not leave any blanks unless directed
· Within eIRB, upload a copy of the completed form in the protocol section of the study application.
A. Principal Investigator Requirements:
Yes N/A – The investigator and research staff are aware of and have been educated about the specific requirements of DoJ research funded by NIJ
B. Privacy Certificate (PC) Requirement:
All applicants for Office of Justice Programs (OJP)/National Institute of Justice (NIJ) funds must submit a Privacy Certificate (PC) approved by the NIJ Human Subject’s Protection Officer. The PC describes the research, assures the applicant will comply with its requirements, and details the procedures in place to protect the subject’s confidentiality of identifiable information collected as part of the research.
Yes N/A – Projects have a Privacy Certificate approved by the NIJ human subject’s protection officer
C. Confidentiality Requirements
Provide a response for all items listed below.
1. Yes N/A – All investigators and research staff have signed an employee confidentiality statements, which are maintained by the PI
2. Yes N/A – The confidentiality statement on the consent document states that confidentiality can only be broken if the subject reports immediate harm to subjects or others
3. Yes N/A – A privacy certificate has been issued for this project. Consequently, the investigator and research staff do not have to report child abuse unless the subject signs another consent document to allow child abuse reporting
D. Progress reports and Publication Requirements:
Provide a response for all items listed below.
Yes N/A – The investigator will ensure that a copy of all data will be de-identified and sent to the National Archive of Criminal Justice Data, including copies of the informed consent document, data collection instruments, surveys, or other relevant research materials.
Note to investigators:
The Department of Justice has several requirements that must be met for research studies funded or supported by the National Institute of Justice. Prior to submitting your application to the IRB, include the following information in the research protocol, consent and application:
· A statement describing the extent to which confidentiality of records identifying the subject will be maintained.
· The subject should be informed that private, identifiable information will be kept confidential and will only be used for research and statistical purposes. If, due to sample size or some unique feature, the identity of the individual cannot be maintained, the participants need to be explicitly notified.
· If the Researcher intends to disclose any information, the participant needs to be explicitly informed what information would be disclosed, under what circumstances, and to whom. The participant must be informed of any risks that might result from this disclosure and must explicitly provide written consent prior to participating in the research.
Version date 04/04/2013 Page 1 of 2