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Online Reliance Consultation Request Form
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Briefly, describe the study or studies for which reliance on a Single IRB (SIRB) is requested:
A reliance request can cover a single study or a group of studies conducted by a certain investigator or institution/organization.
If an ERICA application has been started, please provide the exact title and ERICA IRB number for your study:
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What institution/organization would you like to serve as the single IRB (SIRB) for your study?
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Are you considering any other SIRBs for this study?
Yes
No
Clear
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Provide the names of the sites (institutions and/or organizations) that are expected to be involved in this reliance request:
Please note that we do not serve as the single IRB for international sites.
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Indicate what stage/phase in the overall process the study or studies are currently:
Stage
Protocol development / Planning phase for a grant submission
Ready for IRB submission and review
Currently active protocol
Other - please specify below
Clear
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Who is the sponsor/anticipated sponsor for this study or studies?
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What is the anticipated length of the entire study, from initiation to closeout?
Include the amount of time expected to enroll participants and complete all data analysis.
What are you requesting from the University of Utah IRB? (select all that apply):
Request
We would like the UU IRB to rely on an external SIRB and need documentation of the UU's reliance decision
A SIRB fee quote
The UU IRB's preferred SIRB language for our grant application
Information about how to use the ERICA online application submission system
A letter from the IRB describing our willingness to rely on a SIRB or serve as your SIRB
(e.g. a “Just in Time (JIT)” documentation, letter of support for funding agency, etc.)
Other:
There are no items to display
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Would you like a conference call with a member of the IRB staff to discuss this request?
Please note: The IRB staff may require a consultation call to proceed; we will contact you separately if needed to schedule a call.
Yes
No
Clear
If yes, who should be invited to attend the conference call? Please provide their name, email address, and role in the research.
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Provide the name, email address, and institutional affiliation for the overall lead investigator for the study or studies under this reliance request:
The lead investigator may be the Utah-based investigator.
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Provide the name, email address, and title for the University of Utah investigator and any other personnel you would like included in communications about this reliance request:
Note that the IRB staff may require an investigator involved in the study (or studies) be included in the Reliance Consultation meeting.
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Required
