REQUEST FOR IRB EXEMPTION
Southern Utah University
Institutional Review Board
REQUEST FOR IRB EXEMPTION
Please Read Southern Utah University's 6.20 Policy on Exempt Status Research Before Submitting
this Application
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Principal Investigator E-mail
Phone Number Department
College/School
Academic Year
Position at Southern Utah University
Semester
Fall Spring
Course Number and
Section (if Applicable)
Project Title
Exemption category applied for (check YES or NO to all that apply)
(1) Research conducted in established or commonly accepted educational settings, involving
normal educational practices, such as (i) research on regular and special education instructional
strategies, or (ii) research on the effectiveness of or the comparison among instructional
techniques, curricula, or classroom management methods.
YES NO
(2) Research involving the use of educational tests (cognitive, diagnostic, aptitude,
achievement), survey procedures, interview procedures or observation of public behavior,
unless: (i) information obtained is recorded in such a manner that human subjects can be
identified, directly or through identifiers linked to the subjects; and (ii) any disclosure of the
human subjects' responses outside the research could reasonably place the subjects at risk of
criminal or civil liability or be damaging to the subjects' financial standing, employability, or
reputation.
YES NO
(3) Research involving the use of educational tests (cognitive, diagnostic, aptitude,
achievement), survey procedures, interview procedures, or observation of public behavior that is
not exempt under paragraph (b)(2) of this section, if:
(i) the human subjects are elected or appointed public of
ficials or candidates for public of
fice; or
(ii) federal statute(s) require(s) without exception that the confidentiality of the personally
identifiable information will be maintained throughout the research and thereafter
.
YES NO
(4) Research involving the collection or study of existing data, documents, records, pathological
specimens, or diagnostic specimens, if these sources are publicly available or if the information
is recorded by the investigator in such a manner that subjects cannot be identified, directly or
through identifiers linked to the subjects.
YES NO
(5) Research and demonstration projects which are conducted by or subject to the approval of
department or agency heads, and which are designed to study, evaluate, or otherwise examine:
(i) Public benefit or service programs; (ii) procedures for obtaining benefits or services under
those programs; (iii) possible changes in or alternatives to those programs or procedures; or (iv)
possible changes in methods or levels of payment for benefits or services under those
programs.
YES NO
(6) Taste and food quality evaluation and consumer acceptance studies, (i) if wholesome foods
without additives are consumed or (ii) if a food is consumed that contains a food ingredient at or
below the level and for a use found to be safe, or agricultural chemical or environmental
contaminant at or below the level found to be safe, by the Food and Drug Administration or
approved by the Environmental Protection Agency or the Food Safety and Inspection Service of
the U.S. Department of Agriculture.
YES NO
(7) Research required by students in a course, for completion of the course
requirements, where only non-sensitive information is collected from participants, or all
foreseeable risk are minimized or eliminated.
YES NO
(8) Research for Internal Agency Use: Research done by or at the request of an
internal agency for their own use, and which is not intended to contribute to
generalizable knowledge (i.e. knowledge shared by professionals in a given field
which is designed to contribute to that field).
YES NO
NOTE: The IRB retains final judgment as to whether a particular activity is exempt or whether
it requires another category status.
Please Provide a Detailed Description of Your Research Project. (Include information about
participants, method of recruitment, study design, materials to which participants will be
exposed, etc. Not providing enough detail regarding the study methodology, materials, etc. can
result in the exemption request being denied.)
Exemption Justification. Please Explain why the Exemption Status Applies to this
Research Project.
Principal Investigator's Signature
(Typed Signature is Acceptable)
Date
Faculty Supervisor's Signature if PI is a Student
(Typed Signature is Acceptable)
Please submit this proposal via email to irb@suu.edu along with all applicable
attachments and supplemental materials.