Application for Continuing Review / Progress Report Submission If a study must be reviewed at the convened IRB, the progress report and all required materials must be provided and all required training and conflict of interest disclosures must be complete at least three (3) weeks in advance of the scheduled meeting for which the study will be reviewed. If the continuing review is eligible to be expedited, the progress report and all required materials must be provided and all required training and conflict of interest disclosures must be complete at least three (3) weeks in advance of the expiration date. WARNING: If you need to make an amendment at the time of continuing review, it is best to submit a separate amendment package so the amendment does not interfere with the continuing review or create a lapse in continuing review. GENERAL INFORMATION Protocol Title: Research Foundation (RF) Award Number, if applicable: Principal Investigator (PI):
TABLE OF STUDY STAFF: For training and conflict of interest disclosure requirements see: a. Name & degree b. Role(s) on Project. Examples: Principal Investigator, Coordinator, Consultant, Fellow, Resident, Student, Research Staff, Healthcare Operations only, Access to de-identified data only, Specimen shipment, etc. c. Place of employment REMINDER: is also required for all NYC H+H research. d. Will this person be obtaining verbal or written Informed Consent/Authorization e. Is this person an “Investigator for the purposes of COI reporting”? THE PI IS ALWAYS CONSIDERED AN INVESTIGATOR FOR COI PURPOSES. f. Will this person aid the shipment of hazardous materials (e.g., dangerous goods, specimens) to be transported by a public carrier? SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No
a. Name & degree b. Role(s) on Project. Examples: Principal Investigator, Coordinator, Consultant, Fellow, Resident, Student, Research Staff, Healthcare Operations only, Access to de-identified data only, Specimen shipment, etc. c. Place of employment REMINDER: is also required for all NYC H+H research. d. Will this person be obtaining verbal or written Informed Consent/Authorization e. Is this person an “Investigator for the purposes of COI reporting”? THE PI IS ALWAYS CONSIDERED AN INVESTIGATOR FOR COI PURPOSES. f. Will this person aid the shipment of hazardous materials (e.g., dangerous goods, specimens) to be transported by a public carrier? SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No
I have already received approval from the impacted or involved Department chair(s), BUT I have not previously shared and / or obtained e-signature from the impacted or involved Department chair(s) for the IRB for records. Therefore, I have shared this study with the impacted or involved Department chair(s) and (s)he has e-signed this package. I have not yet obtained approval from the impacted or involved Department chair(s). If you selected this response, please share this IRB Submission with the impacted or involved Department chair(s), so that (s)he may electronically sign the submission 9) SIGNATURES The IRBNet package must be electronically signed by the PI before submitting the package to the IRB. If Pharmacy, Pathology, or an additional Department Chair is conducting an ancillary review, please have the designated individual e-sign the submission. If the IBC is reviewing the research, please provide a copy a copy of the IBC approval letter.