Online Reliance Consultation Request Form
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 you know the exact title of the study, please include it in the description. If an ERICA application has been completed, please include the IRB number.
Provide the names of the sites (institutions and/or organizations) that are expected to be involved in this reliance request:
This should include all institutions and organizations that will need Reliance Consultation with the University of Utah Human Research Protection Program (HRPP).
What institution/organization would you like to serve as the single IRB (SIRB) for your study?
Indicate what stage/phase in the overall process the study or studies are currently:
Protocol development / Planning phase for a grant submission
Ready for IRB submission and review
Currently active protocol
Other - please specify below
Who is the sponsor/anticipated sponsor for this study or studies?
What are you requesting from the IRB at this point:
Just in time approval/letter of support
Information on the SIRB process
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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.
Indicate who will be the lead investigator (and/or Utah-based participating investigator) for the study or studies under this reliance request:
The lead investigator may be the Utah-based investigator.
Provide the name and contact information for the individual(s) the University of Utah HRPP should contact to set up the Reliance Consultation meeting:
Note that an investigator involved in the study (or studies) must be included in the Reliance Consultation meeting.