Appendix L1 – Institutional Review Board (IRB)/Independent Ethics Committee (IEC) Authorization Agreement
Version 1.0 8/09/07 / Office for the Protection of Research Subjects (OPRS)
Institutional Review Board (IRB)
1737 West Polk Street (MC 672)
203 Administrative Office Building
Chicago, IL 60612
Phone: 312.996.1711 Fax: 312.413.2929
www.research.uic.edu
Name of Research Project:
Name of Principal Investigator:
Sponsor or Funding Agency:
Award Number, if any:
Other support, describe:
Name of Institution Providing IRB Review (Institution A): University of Illinois at Chicago (UIC)
OHRP Federalwide Assurance (FWA) Number: FWA00000083
IRB Registration #: (choose): IRB00000115 UIC IRB #1
IRB00000116 UIC IRB #2
IRB00000117 UIC IRB #3
Name of Institution Relying Upon UIC IRB Review (Institution B):
OHRP Federalwide Assurance (FWA) Number:
The Officials signing below agree that Institution B may rely on the UIC IRB for review, approval, and continuing oversight provided by the University of Illinois at Chicago under its Assurance for the project identified above.
This agreement is applicable only to the project named above and to no other research in which Institution B may be engaged in presently or in the future.
The review, approval, and continuing oversight performed by the relied-upon UIC IRB will meet the requirements of the HHS regulations for the human subject protection at 45 CFR 46, as well as the requirements of UIC’s OHRP-approved Assurance. The UIC IRB will follow its written procedures for reporting its findings and actions to appropriate officials at Institution B. Relevant minutes of IRB meetings will be made available to Institution B upon request.
Institution B remains responsible for ensuring compliance with the IRB’s determinations and with the terms of its OHRP-approved FWA, or other applicable laws or regulations.
This document must be kept on file at both institutions and must be provided to OHRP upon request.
Signatures:
Authorized Official at the University of Illinois at Chicago (Institution A):
______Date: ______
Mitra Dutta, PhD
Vice Chancellor for Research
Authorized Official at Institution B:
______Date: ______
Print Full Name:
Institutional Title:
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