Institutional Review Board (IRB) Collaborating Institution Authorization Agreement (Agreement between two Institutions with FWAs, also called an Independent Ethics Committee Authorization Agreement, to designate and rely on one IRB.)

Name of Institution Providing IRB Review (A): IRB Registration No.: FWA No.:

Name of Institution Relying on the Designated IRB (B): IRB Registration No.: FWA No:

Title of Research Project: Name of PI and Contact Information at Institution A: Sponsor or Funding Agency: Award Number, if any: IRB Approval No. and Date: Name of PI (or contact) and Contact Information at Institution B:

Check one: This agreement applies to all human subject research conducted between collaborating PIs at Institution A & B and covered under a FWA.

This agreement is limited to the following specific protocol(s):

The review performed by the designated IRB will meet the human subject protection requirements of Institution B’s OHRP-approved FWA. The IRB at Institution A will follow written procedures for reporting its findings and actions to appropriate officials at Institution B. Relevant minutes of IRB meetings will be made available to Institution B upon request. Institution B remains responsible for ensuring compliance with the IRB’s determinations and with the Terms of its OHRP-approved FWA. This document must be kept on file by both parties and provided to OHRP upon request.

The collaborating PI is required to provide the necessary information to the IRB of record, such as the IRB approval letter, and copies of the annual and final reports.

The Officials signing below agree that (insert name of Institution B) may rely on the designated IRB for review and continuing oversight of the human subjects research described in this agreement: Signatory Official Signature (Institution A): Date:

Printed Name:Louise Griffin Institutional Title:Vice Chancellor, Administration & Finance NOTE: The IRB of Institution A must be designated on the OHRP-approved FWA for Institution B Signatory Official Signature (Institution B): Date:

Printed Name: Institutional Title:

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