<p>The University of Texas at El Paso Animal Care and Use Committee COLLABORATIVE RESEARCH REQUEST FORM **Below for IACUC Office Use** Date Received: (See page 2 for further guidance.) Date Approved:</p><p>Database: Title of Collaborative Project: </p><p>Attach a copy of the approved protocol to this request form. UTEP Principal Investigator (s): Department(s): Telephone: Fax: Email: </p><p>Purpose of study: Material(s), if any, to be sent to collaborating institution: Material(s), if any, to be received from collaborating institution: Collaborating Institution: Principal Investigator (s): Protocol Number: Approval Period: IACUC Contact: Phone: Email: </p><p>NIH (OLAW) Assurance No: </p><p>If the Institution is not assured, an Assurance of Compliance/Inter-institutional Agreement must be executed.</p><p>I understand that protocol work will not be implemented at UTEP until I receive approval from The Institutional Animal Care and Use Committee. UTEP PI Signature: Date: </p><p>APPROVALS: Attending Veterinarian certification of oversight review, and consultation on proper use of anesthetics and pain relieving medications for any painful procedures:</p><p>Name: Signature: Date: </p><p>Certification of review and approval by the Institutional Animal Care and Use Committee:</p><p>Name: Signature: Date: </p><p> Please mail or bring a signed copy of this form to the IACUC Office, Burges Hall, Room 407.  Guidelines for executing a collaborative animal use protocol follow on page 2. C- </p><p>New Form 07/2008 Collaborative Research Request Form, Page 1</p><p>Additional IACUC forms are available on the web http://research.utep.edu/Default.aspx?tabid=39520 The University of Texas at El Paso Guidelines for Collaborative Protocols</p><p>1. The collaborating institution has an active “Assurance of Compliance with Public Health Service (PHS) Policy on Humane Care and Use of Laboratory Animals” with the Office of Laboratory Animal Welfare (OLAW). </p><p> a. The Principal Investigator submits a “Collaborative Research Request Form” with a copy of the approved protocol to the Institutional Animal Care and Use Committee. (Copies of subsequent reviews/amendments should be submitted to The University of Texas at El Paso’s (UTEP’s) IACUC as they occur.) </p><p> b. The Principal Investigator ensures a Memorandum of Understanding (MOU) is executed between the two institutions so there is a clear understanding of the institutions’ respective responsibilities. The MOU is processed through the Office of Research and Sponsored Projects. </p><p> c. When UTEP accepts IACUC approval from a PHS-assured institution where the animals are housed and the animal activities are being conducted, the IACUC at the housing and performance site remains responsible for the animal activities in its facilities.</p><p> d. UTEP participants are required to meet UTEP’s Animal Care and Use Training and Screening Requirements prior to beginning contact with animals at UTEP’s facilities. </p><p>2. The collaborating institution does not have an active “Assurance of Compliance with Public Health Service Policy on Humane Care and Use of Laboratory Animals” with OLAW.</p><p> a. If the protocol involves the use of PHS funds, OLAW negotiates an “Assurance of Compliance/Inter-institutional Agreement” when an awardee institution without an animal care and use program or IACUC will rely on UTEP’s program. The inter-institutional agreement is processed through the Office of Research and Sponsored Projects. </p><p> b. UTEP’s IACUC will review the animal use protocol through normal procedures, and verifies, through the inter-institutional agreement, UTEP’s review and approval of the protocol.</p><p> c. The institution at the housing and performance site assumes the responsibility for the animal activities at its facilities.</p><p>Reference: OLAW Notice NOT-OD-01-017, February 2001 Guidelines approved by UTEP IACUC, 31 July 2008</p><p>New Form 07/2008 Collaborative Research Request Form, Page 2</p><p>Additional IACUC forms are available on the web http://research.utep.edu/Default.aspx?tabid=39520 </p>