Attach responses to each of the following:
1. Identify the participant population. Explain the rationale, report if the population
includes a vulnerable group such as prisoners, children, the mentally disabled, or
those whose ability to give informed consent may be in question.
2. Describe and assess the likelihood and seriousness of any potential risks of a
physical, psychological, social, occupational, financial or legal nature that may
occur for participants.
3. Describe procedures, including confidentiality safeguards, for protecting against
or minimizing potential risks.
4. Assess the potential benefits to be gained by the individual participant, and/or
benefits that may accrue to society as a result of the research; analyze the
risk/benefit ratio.
5. Compose a statement in layman’s language explaining the project
6. Enclose a copy of the Informed Consent document to be used in the research.
Refer to the Operational Guidelines of the Meredith IRB for a full description of
the elements of consent.
Application for IRB authorization [ ____is] [ ____ is not] approved.
Signature of IRB Chairperson______________________________________________
Date of decision ___________________________________, and if approved…
Approval expiration date________________________________________
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