Wichita State University Institutional Review Board (IRB)
Oversight Determination Worksheet
RTT July 2017
Project Title:
Principal Investigator:
Funding Source:
PI on Grant or Contract:
Proposal #:
RTT contact for the grant or contract:
This form is intended to assist researchers in determining whether or not a project involves research with human
subjects and whether or not WSU is engaged in research. The IRB Office will make the final determination and issue
a formal determination for your records.
SECTION 1 Description
Provide a description of the project, including what people will be asked to do and what data will be accessed or collected:
SECTION 2 Questions
The project involves interviews, focus groups, surveys, questionnaires, etc.
Yes No
A copy of the planned or sample questions are attached.
Yes N/A
SECTION 3 Funding
Funding application, contract, and/or data use agreement is attached.
Yes N/A
2
SECTION 4 Purpose
Is the purpose of the project is to:
a) generate information that may be broadly applied to the group or condition under study
Yes No
b) develop a tool or method that could be used to create generalizable information
Yes No
c) conduct a pilot study that may inform a funding application or larger study
Yes No
d) submit a manuscript for publication
Yes No
e) present at a conference
Yes No
f) complete a thesis or dissertation with placement in WSU Library
Yes No
g) provide an education experience for a WSU student
Yes No
h) evaluate improve or inform practice, program, or curriculum
Yes No
i) conduct quality improvement or assurance activities
Yes No
j) fulfill a contractual agreement (e.g., fee-for-service) without academic credit
Yes No
Comments or further explanation of the above:
SECTION 5 Human Subjects
Is the project about one or more living individuals?
Yes No
Is the project about a company, practice, policy, or similar, rather than a person; and is that clear in
the project description and data collection instruments?
Yes No
Does the project involve (see link at the bottom of the page for definitions):
a) an intervention or interaction with these individuals?
Yes No
b) identifiable information or specimens from these individuals?
Yes No
c) private information about these or other individuals?
Yes No
d) pre-existing data collected for a reason other than this project?
1
Yes No
Comments or further explanation of the above:
SECTION 6 WSU Engagement
WSU is the primary awardee on a grant or contract
Yes No
WSU is a sub-awardee on a grant or contract
Yes No
WSU is the only site of research
Yes No
WSU employees or students are:
a) obtaining consent or assent from human subjects
Yes No
b) interacting or intervening with human subjects
Yes No
c) obtaining/receiving identifiable, private information or biological samples
Yes No
Comments or further explanation of the above:
PI signature Date
Email completed worksheet and all relevant attachments to: IRB@Wichita.edu
1
Office for Human Research Protections website. “Guidance on Research Involving Coded Private Information or Biological
Specimens.” http://www.hhs.gov/ohrp/policy/cdebiol.html
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