Human Subjects Research Review Committee

Human Subjects Research Review Committee

Human Subjects Research Review Committee

ITC, Biotechnology Building, Room 2204

Tel. (607) 777 – 3818

Fax: (607) 777 – 5025

Annual Continuing Review Request Form

Copies of this application form and other IRB resources can also be found at:

Date:

Principal Investigator(s):

Dept.:

E-mail:

Phone:

Title of Project:

Protocol Number:

  1. Protocol Status

Protocol is active – work in Progress / Please check one:
Participant recruitment, enrollment, and interactions are on-going.
Enrollment is closed, but subjects are still undergoing studying procedures.
Data analysis of identifiable data only.
Work completed / STOP! Complete “Protocol Closure Form” instead of this form.
Work on protocol will not be done / STOP! Complete “Protocol Closure Form” instead of this form.

For all active protocol in which participant enrollment is on-going, please include one copy of your current consent form(s).

Consent form(s) attached

Not applicable

  1. For sponsored research (e.g., grant funded) report all changes that have been made or will be made to the sponsor application or award-related to the use of human subjects. Submit one copy of the revised grant information with the relevant human subjects sections highlighted.

Not applicable

Application/grant has not been revised

Revised application/grant is attached

  1. If your research has not yet started, provide reason for the delay and submit this form.
  1. Provide the following information for research involving human subjects for the current approval period.
  2. The number of participants approved for this research study:
  3. The number of participants enrolled to date (completed informed consent process):
  4. The number of participants who withdrew or discontinued participation in the research to date:
  5. The number of participants who completed the study:
  6. Have any participants become incarcerated? Yes No

If yes, please indicate number:

  1. Provide a brief summary of the work completed so far.
  1. A brief summary of any amendments or modifications you will be making to the currently approved protocol. Please submit a modification form along with this form (Modification form can be found here:

none

  1. A brief summary of any adverse events or unanticipated problems that were possibly related to participation in this research.

none

  1. A brief summary of the reasons for participant withdrawal and any complaints about the research since the last IRB review.

none

  1. A summary of any relevant literature, interim findings, etc. affecting the risk/benefit ratio of this study.

none

  1. Are you aware of any new findings that may relate to the participants’ willingness to continue in this research project? If so, describe.
  1. Were any unexpected benefits to the subjects discovered during this review period?

If the Annual Continuing Review Request Form is not provided to the HSRRC or if the HSRRC has not approved a protocol by the expiration date, all research procedures related to the protocol under review must cease, including recruitment, advertisement, screening, enrollment, consent, interventions, interactions, and collection of private identifiable information.

Updated 1/5/17 1

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