I1D FO5 Request for Research Involving the Department of Defense

I1D FO5 Request for Research Involving the Department of Education

Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99)
Protection of Pupil Rights Amendment (PPRA) ((20 U.S.C. § 1232h; 34 CFR Part 98)

Date:
Principal Investigator:
Protocol Title:
UNR Protocol Number:
Sponsor:
Additional regulations apply to research that is sponsored by the Department of Education (DoEd), including research at schools receiving DoEd funds. The information requested below is necessary for the Institutional Review Board to verify that these additional requirements (FERPA and PPRA) for the protection of human subjects have been sufficiently addressed. Complete this form and submit the signed original and one copy.
  1. Indicate if the proposed research is funded by DoEd, either directly or as pass-through funds, or the research is taking place at schools receiving DoEd funds.
No DoEd funds involved
DoEd-sponsored grant or other award
Performance sites are DoEd-funded schools
  1. Indicate which of the additional regulations apply:
FERPA, complete the FERPA section
PPRA, complete the PPRA section
FERPA and PPRA, complete both sections
Neither FERPA nor PPRA apply; explain why these regulations do not apply:

For Research Involving FERPA Only

  1. For research involving student education records, if the required basic information has been provided in the Privacy section of the protocol application and consent documents state so; if not, provide it here (see guidance I1D GD5 for requirements):

  1. Are you requesting an exception to the requirement to obtain parent or adult-student consent for the release of student education records?
No
Yes, indicate which of the following exception applies (check one):
Research involves only directory information
Research is being conducted for an education agency and is restricted to the following (check one and attach the required agreement between the investigators and involved education agency):
Develop, validate, or administer predictive tests.
Administer student aid programs.
Improve instruction.
  1. If the exception has been addressed in the Privacy section of the application state so; if not, describe and justify the request here:

For Research Involving PPRA Only

  1. For research involving protected information, if documentation of compliance from the school or agency has been provided, or the required basic information has been included in the Privacy section of the protocol application and consent documents state so; if not, provide it here (see guidance I1D GD5 for basic requirements):

Indicate which of the following protected information will be involved in this research:
political affiliations;
potentially embarrassing mental/psychological problems of student or parents;
sex behavior and attitudes;
illegal, anti-social, self-incriminating or demeaning behavior;
critical appraisals of persons with whom the student has close family relationships;
legally recognized privileged relationships (e.g., with lawyers, doctors, ministers); and
income (other than that required for program eligibility or financial assistance)
  1. Indicate which process will be used for obtaining parent consent:
Written parent consent will be obtained
Parent opt-out process will be used because the following apply:
Research not funded by DoEd
Research involves other protected information, describe:
  1. If information about how parents will be allowed to inspect the surveys or instructional materials involving the use of protected information for the research is in the Privacy section of the application, state so; if not in the application, describe here:

Principal Investigator Signature

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