IRB-HSR Home Institutional Review Board for Health Sciences Research
Researchers IRB Members Research Subjects IRB STaff







+ Calendars & Deadlines
+ Office Information
+ Directions & Hours
+ Staff Directory
+ Frequently Asked Questions
+ IRB-HSR Membership Lists
+ FWA Information
+ Organizational Charts
+ Research Concerns
+ Standard Operating Procedures
+ Getting Started
+ Protocol Review Process
+ Managing Protocol After Initial Approval
+ Special Issues
+ Protocol Builder and IRB On-Line: On Grounds or UVa VPN access only
+ Forms
+ CITI Training
+ Education
+ Regulations/Guidelines
+ Ethical Principles
+ Search IRB-HSR Protocols
+ Glossary/Acronyms
+ Useful Websites
+ Go to full list >>


IRB-HSR > Forms








Advertising Approval Checklist 05/03/11
Advertising Submission Checklist 05/27/11
Age of Majority Addendum  
Age of Majority Cover Letter  
Aggregate Review Form 05/25/10
Alternative IRB of Record - Forms  
Closure Form for Grants 11/15/13
Closure Form for Protocols 08/24/15
Consent Addendum: Adult or Minor 05/24/11
Consent Addendum: Prisoner  
Consent Short forms for non-English Speaking Subjects 05/01/13
Copy Request Form 11/15/12
DSMB Charter Template  

Data Use Agreement with Instructions to PI

dbGaP Submission Certification Request Form 08/24/15
Determination of Human Subjects Research Form 04/23/15
Determination of UVa Agent Form 03/19/15
Document Submission Form 04/23/14
Emergency Use Notification to IRB-HSR 12/07/11
Exit Checklist  
Grant Information Form 09/09/15
HIPAA Authorization- Stand Alone 02/07/13
HIPAA Authorization - Stand Alone: Spanish 02/07/13
International Consent Form Template  
Investigator's Agreement 08/28/12
Investigator’s Agreement: protocols not overseen by IRB-HSR 05/15/15
IRB Authorization Agreements Request Form 02/03/14
Modification Forms
Change of Status Modification Form 12/18/14
Enrollment Change Modification Form 04/23/14
Personnel Change Modification Form 09/22/15
5-Year Summary Form - Expedited Protocols 02/22/13
5-Year Summary Form - Full Board Protocols 02/22/13
Request for Modification Form 02/26/15
Medical Records Request Form  
MRI Dry Run Consent Template 04/16/12
New Expedited Protocol Submission Checklist 01/20/11
Non-UVa Batch AE Submission Form 05/25/10
Prescreening Document / Screening Log / Enrollment Log  
Post Debrief Release Form for Deception Studies  
Pregnant Partner Addendum Template  
Protocol Information Form- Humanitarian Device Exemption 05/25/10
Protocol Violation, Noncompliance, and Enrollment Exception Reporting Form 03/11/15
Public Data Set Nomination Form 09/16/11
Routing Form 04/23/14
SOM Form:  Determination of Capacity to Consent  
Sponsor Addition Form 05/25/10
Submission Checklist - Expedited 04/23/14
Submission Checklist - Full Board 04/23/14
Unaffiliated Investigator Agreement - English 07/04/14
Unaffiliated Investigator Agreement - Spanish 07/31/12
Unanticipated Problem Report Form 05/25/10
Tip:  If the pagination in Microsoft Word documents appears incorrect (ex: page 1 of 1, page 2 of 2), click on Print Preview while in the document.  This forces Microsoft Word to reset the total page counter (ex: page 1 of 2, page 2 of  2).