Fill - Free fillable Irb-annual-renewal-form - IRB Annual Renewal Notice PDF form

Rev. November 16, 2017

TowsonUniversityInstitutionalReviewBoard

AnnualReviewNotice

PrincipalInvestigator:__________________________________Protocol#______

_____________

ProtocolTitle:_____________________________________________________________________

LastApprovalDate:__________________ExpirationDate:______________________

Note: A progress report must be submitted with this form. PrincipalInvestigatorsarerequiredto

assuretheconfidentialityofalldataandanybreachofconfidentialitymustbereportedtotheIRB.

ProjectStatus(Checkallitemsthatapply):

INACTIVE–nofurthercontactwithhumanparticipantsorrecordsarerequired:

____Originaldataand/orresearchmaterialhavebeendestroyed

____Thelinkagesbetweenexistingdataandoriginalsourceofinformationhavebeen

destroyed.Noindividualscanbeidentifiedfromexistingdata.

____Thedatawithidentifierswillberetained–submitaseparatememorandu

mindicatingwhy

suchdatawillberetaine d, whereandforhowlong.Annualreportswillberequired.

ACTIVE–contactwithhumanparticipantsisstillrequired

____subjectinterviewsarestillrequired

____dataarestillbeingcollectedfromrecordsorothersources

____dataarestillbeinganalyzed

____originalproceduresforprotectinghumansubjectsarestillineffect.Attachthecurrent

informedconsent.

Yes No Attachadditi

onalinformationforallitemsmarked“Yes”



Evidencefromyourexperiencetodateorfromrecentliteratureindicatestheexistenceof

risksdifferentfromthosepreviouslydescribed

Hasthestudyhasbeenactiveforthreeyears?

Havetherebeenanywithdrawalofparticipantsfromtheresearch?

Havetherebeenanycomplaintsabouttheresearch?

Whatisthenumberofsubjectsaccruedthisyear?

Whatisthenumberofsubjectsaccruedsincethestudybegan?

InvestigatorSignature:__

______________________________Date:__________________________

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