ANIMAL MATERIAL USE FORM (AMUF)
UNL Institutional Animal Care Program (IACP)
110 Mussehl Hall, East Campus
University of NebraskaLincoln
402-472-4486
Submission of an AMUF to the Institutional Animal Care Program is not mandatory. Users of animal material(s) are encouraged to register animal material(s) use with the IACP by submitting an AMUF. Submission of the AMUF alerts the IACUC of the Investigator’s use of animal material(s). Consequently, the IACUC can become an active supporter of the individual using animal material(s) and the described use of the animal material(s). The IACUC strongly supports the concept of reduction of use of live vertebrate animals whenever possible by replacement with animal material(s) through sharing of animal material(s) from approved IACUC protocols or other approved sources. The AMUF is for studies that do not use LIVE vertebrate animals.
Principle Investigator: / Department: / Phone: / Email:Funding source, if applicable:
Supply common name of species used as source of animal material(s). / Common name:
Scientific name, stock, strain, breed:
Purpose and benefit of animal material(s) used:
Describe how the animal material(s) will be used:
Indicate type of animal material(s) to be used:
List all specific body parts, organs, tissues, cells, body fluids and any other animal material(s) to be used.
Indicate the source of animal material(s).
Indicate name of investigator/researcher/institution
donating animal material(s).
List IACUC protocol numbers if material(s) will be donated from an approved project.
Describe where the animal material(s) will be stored and used.
Describe method of animal material(s) disposal.
Do the animal material(s) contain hazardous agent(s)? / Biohazard Radioisotope Chemical Hazard
Assurances
I assure that all applicable laws and regulations have been followed and that all required permits and licenses (Federal, State, Local) have been obtained to allow collection and use of the animal material(s) described in this AMUF.
I have attached a copy of any external institution’s or company’s IACUC approval document(s), if applicable, allowing the use of materials after euthanasia of animals used on another protocol as the source of animal material(s) in this AMUF.
I understand that an IACUC approved protocol is required if ante-mortem procedures are used in the harvesting of the animal material(s) for my use.
I assure that the animal material(s) were collected after the animals had been euthanized and any animal material(s) collected prior to euthanization were obtained as stated in the original IACUC approved protocol(s).
I assure that no additional animal(s) are euthanized under my approved protocol for the purpose of the collection of animal material(s) used under this AMUF.
It should be assumed that ALL animal material(s) may contain possible pathogen(s) or hazard(s) and all animal material(s) should be handled appropriately, regarding it as a source of possible infection or hazard.
Receiving Investigator:
Signed:______Date:______
Donating Investigator/Representative:
Signed:______Date:______
Designated IACUC Official:
Signed:______Date:______
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