ÌÇÐÄVlog

Other Forms & Tools

Forms

FormDescription
Use to request an amendment to an approved IRB protocol.  (Must be accompanied by the updated protocol with changes in underlined text.  Only include documents that have changed.)
Use this form to request any alteration to the informed consent process, HIPAA authorization or letter of cooperation.
See  requirements based on approval type.
Use to report adverse events or unexpected events during the course of a research project.  Unrelated events do not need to be reported. (e.g., subject injury in a car accident on the way to the intervention)
Additional information required in an informed consent for use of PHI
Use to certify receipt of data in a de-identified format for HIPAA Safe Harbor purposes
Use this form to disclose a potential conflict of interest where the researcher has a financial interest in the outcome of the human subjects research.
Direct link to the termination portal

Tools

NameAdditional Information
 Confidentiality Agreement for Use with work for hire translation/transcription/statistics
 ÌÇÐÄVlog license to use student photo for commercial and educational purposes
 ÌÇÐÄVlog license to use student work for commercial and educational purposes
A waiver of liability for students participating in research projects as student researchers. Waivers should be maintained by the faculty member.  If the faculty member leaves GS, all current waivers (less than 3 years or for ongoing field work) must be turned over to the departmental office for retention.
Use where identifiable or restricted use data is shared with Research Associates
Use where 3rd party is used to distribute research materials but is not party to research or GS student
Used were GS faculty collaborate with investigators who are not associated with federally assured institution.
Use with informed consent where deception or incomplete information is provided to support research aim.
NIH issued to protect identifiable research information from forced disclosure
Use to set up an agreement for the sharing of data in a collaboration (Special uses – HIPAA and FERPA data transfer)

Policies

NameAdditional Information
Policy on the use of human subjects incentives.  (Use form below to record distribution/for reimbursement)
Use to record distribution of research incentives. Tab 2 records incentives outstanding over 30 days.(Note: where incentives are dispersed as cash, a bank withdraw receipt for that cash is recommended for reimbursement documentation.)Use account code – 751110 – Other Per Diems (This would be used if the researcher is requesting the money up front for the incentives) OR 752100 – Reimbursable Expense (This would be used if the researcher has already given out the incentives and is requesting reimbursement)
Use where GS faculty is not the PI and another IRB will hold primary approval or the Co-PIs are from other institutions and will rely on our approval.If you are requesting to rely on another IRB’s approval, please submit  along with the supporting documentation.
Georgia Southern policy on requests from on-campus and off-campus entities for the distribution of surveys to various populations –  Note: This policy is not an IRB policy and approvals are administered through the Provost’s Office.