Forms

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Document Name Link to Document Type Summary
Assent Document Template Assent Document Template29.17 KB Forms, Templates

An Assent document is used for children aged 7-17 or cognitively impaired adults who are unable to provide legal consent, but allows them to provide their understanding and agreement to research participation.

Certificate of Translation Form Certificate of Translation Form94.02 KB Forms

For research conducted in languages other than English, the Illinois IRB must have all versions of the research material [e.g. consents, recruitment, instruments, etc.] in both English and non-English to be retained in the research file.

Consent and Authorization Document Template Consent and Authorization Document Template40.03 KB Forms, Templates

This template includes Authorization for the use of Protected Health Information.  This template should be used for research conducted with HIPAA-protected data. 

Consent Cover Letter Template Consent Cover Letter Template23.8 KB Forms, Templates

This template should be used as a consent document for simple survey or questionnaire research.  This document should be used when a signature will not be collected. For example, for an online survey the participant reads this consent cover letter which informs them about the study and if they agree to participate, they proceed and complete the survey.  Consent is implied by the fact that the participant completed the survey, or participated in the focus group, or answered the interview questions.  To utilize this form, a Waiver of Documentation of Consent must be requested on the Informed Consent Process Form.

Consent Document Template Consent Document Template35.18 KB Forms, Templates

This is a standard consent document template to be used for adult participants in social behavioral or biomedical research.  This standard template is geared towards minimal risk research.  Please review the Supplemental Consent Language document for additional consent requirements for greater than minimal risk research and other study-specific requirements.

Debriefing Document Template Debriefing Document Template.docx22.57 KB Forms, Templates

A debriefing document is needed when a study involves deception, incomplete disclosure, or studies designed in such a way that providing complete background information will invalidate the study.  The debriefing document is provided to the participant following their participation to give them full information about the study.  An Alteration of Consent is required in order to use deception or incomplete disclosure in research.  Submit a Waiver of Informed Consent Form as it includes the Alteration of Consent request.

Department of Defense Supplement Form Dept of Defense supplement form version D0123.docx76.02 KB Forms

This form should be completed and submitted as part of the IRB application for any project that has involvement in any capacity from the Department of Defense.

Final Project Report Form Final Project Report Form90.69 KB Forms

The completion or termination of a study is a change in activity and must be reported to the IRB. 

At the time a study is complete or discontinued, the investigator must submit a Final Project Report.

Form for Reporting a Research Complaint or Concern Form for Reporting a Research Complaint or Concern58.37 KB Forms

This form can be used by participants, research staff, and others to report potential complaints or concerns about research.  Individuals can choose to remain anonymous.  You also have the option of being known to OPRS, but anonymous to the researcher.  

This form should not be used by a researcher informing OPRS about a complaint made by a research participant.  In that case, the researcher should follow standard reporting guidelines by using a Report Form application.

Information Sheet Template Information Sheet Template36.31 KB Forms, Templates

This template can be used to obtain informed consent without a signature.  This template is similar to the Consent Cover Letter template, but includes more details for potentially more involved research than one simple survey.  Consent is implied by the fact that the participant completed the survey, or participated in the focus group, or answered the interview questions.  To utilize this form, a Waiver of Documentation of Consent must be requested on the Informed Consent Process Form.

Parental Permission Template Parental Permission Template36.1 KB Forms, Templates

The Parental Permission form is the consent document that is used when the research participant is a child and the consent is being provided by the parent/guardian.

Participating Site Application Form Participating Site Application Form K0123.docx54.25 KB Forms

The Participating Site Application Form is used when UIUC will be acting as the IRB for an external site.  A site might be another university, a hospital, a company, a community center, or an individual.  

One Participating Site Application Form should be used for each university, company, etc. that is being added to an IRB application.  

A Reliance Consultation is required before adding a site to an IRB application.  Submit a Reliance Consultation Request if you need to schedule a consultation. 

Physician Approval of Radiation Use Physician Approval of Radiation Use Form89.29 KB Forms

State radiation safety regulations require that all radiation administered to humans must be “authorized by a licensed practitioner of the healing arts.” This includes research as well as medical care.

PI Departmental Approval Form Departmental Approval Fillable Form .pdf124 KB Forms

The Campus Administrative Manual defines who is eligible to act as PI of a study. https://cam.illinois.edu/policies/rp-06/ 

As per this policy, upon approval by the applicable academic dean, institute director, or campus administrative officer, an individual in certain other positions may be permitted to act as PI.  

Use this form to document approval by the applicable academic dean, institute director, or campus administrative officer.  Once completed and signed, attach this form in the Documents section of the study application in IRBOnline under the "Other Documents" field.  

The PI's name must be listed on the signed form in order for OPRS to approve the project.  Additionally, a signed form must be attached to each new study application in order for an individual to be approved as PI for each study application.  Additional submissions related to a previously approved study do not require a new form to be attached (i.e. an amendment application does not require a new PI Departmental Approval Form if the PI was previously approved on the new study application and a PI Departmental Approval Form was previously attached).  

Principal Investigator Departure Form Principal Investigator Departure Form2.51 MB Forms

This form should be submitted as soon as an investigator becomes aware they are leaving the University of Illinois at Urbana-Champaign and are engaged in human subjects research on active IRB protocols.

Report Form Report Form66.05 KB Forms

The Report Form (RF) application is used to submit problems, events, or information issues to the IRB for review. These may include Adverse Events, Protocol Deviations, Reports of Non-Compliance, and Unanticipated Problems.

Research Team Form Research Team Form102.81 KB Forms

List all individuals engaged in the research study who are affiliated with the University of Illinois Urbana-Champaign.

Supplemental Consent Language Supplemental Consent Language37.52 KB Forms, Templates

This document contains additional consent template language that can be added to consent documents depending on specific situations.  Specifically, this document includes all consent requirements for Greater than Minimal Risk research.  This document also includes a Table of Contents for ease of use finding the language you need.

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