Research/Project Review and
Approval Form Part A: Decision
Does the research/project fall under the category of
human subjects research?
Directions: Provide a research/project summary and complete the questionnaire, in order to help you determine if your research/project requires
an application submission to the IRB. When you have completed Part A submit this form to the appropriate IRB member. The IRB website has a list
f IRB member, and the unit of the University and State Library that they service.
Summary of Research/Project: Submit a one page summary (or abstract) of your research/project with the following form. Include the following
information in the summary: who are the participants, what you will do, when the research/project will occur, where it will occur, and what you
hope to determine by completing the research/project.
Questionnaire: Complete the following questionnaire to determine if the proposed research/project could be considered human subjects research.
Human subjects are called participants in a research/project study.
1) Will the participants in the research/project be identifiable through records, responses, or personal information to anyone else but the researcher?
2) Could participants’ reputations, financial standing, or legal standing be at risk if their responses were identified? YES NO
3) Does the research/project ask questions about or explore sensitive aspects of participants’ lives, such as illegal conduct, drug and alcohol use,
mental health issues, abuse, or sexual issues? YES NO
4) Does the research/project involve the taking of any images or audio of the participants, via any means, camera, audio, cell phone, etc.?
5) Does the research/project target any of the following types of participants, who are considered vulnerable populations?
Children who are under the age of 18 Physically challenged Economically disadvantaged
Legally incompetent adults Pregnant women Terminally ill
Cognitively or mentally impaired individuals Traumatized or comatose Prisoners
6) Does the research/project involve any of the following activities?
Administration of drugs Taking tissue samples Drawing blood
Administration of alcohol Use of medical devices Giving injections
Administration of nutritional supplements Invasive procedures
7) Is any of the data to be collected online with identifiable email addresses or electronic signatures? YES NO
8) Will any identifying information that may link the data to individual participants be included in your research/project records?
9) Does the research/project involve the study of existing databases where the individual participant data is identifiable? YES NO
10) Are participants voluntarily participating, and are they free to withdraw at any time? YES NO
A yes answer to any of the above questions except question #10 places the research/project in the category of human subject research. If a yes is
answered to any of the above questions except question #10, proceed to Part B:Application for IRB Approval.
IRB Member submitted to: __________________________________________________________ Date Reviewed: _______________
The research/project is determined to be: Research Not Research
IRB member signature: ________________________________________________________________________________________
Communicated to Principal Investigator: Method of communication and date: (IRB member to attach communication)
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