Forms and Templates

Investigators are strongly encouraged to maintain electronic copies of all information (forms and files) submitted to the IRB. These electronic files will be needed in the event revisions are required after review. Additionally, complete revisions of these documents may be required with future submissions. Investigators must retain a hard copy or electronic version of the approved submission as well as the IRB's notification letters as part of the regulatory documentation.

Non-UMass Personnel List Use this form to report personnel outside University of Massachusetts

HIPAA Waiver

Use this form when requesting a waiver of HIPAA authorization

 

Templates

Investigator Study Plan Template with Instructions

Use this template to develop the Investigator Study Plan. Instructions are included within the document.
Updated 5/16/12

Consent Form Template

Use this document to create the consent form for your research.
Updated 3/18/14

Assent Template

Use this document to create an assent form for children involved in research.
Updated 3/18/14

Blood Draw Consent Template

This document may be used when research involves no more than a simple blood draw. 
Updated 3/18/14

Fact Sheet Template

This document may be used when requesting a waiver of the documentation of informed consent. 
Updated 3/18/14

HIPAA Authorization

Use this document to obtain authorization to use /disclose PHI from participants of the research

Short form consent-English

 

Short form consent-Portuguese

Use this form when obtaining and documenting informed consent from a subject who does not speak English

Short form consent-Vietnamese

Use this form when obtaining and documenting informed consent from a subject who does not speak English

Short form consent-Spanish

Use this form when obtaining and documenting informed consent from a subject who does not speak English

Short form consent-Polish

Use this form when obtaining and documenting informed consent from a subject who does not speak English

Short form consent-Arabic

Use this form when obtaining and documenting informed consent from a subject who does not speak English

Short form consent-Laotian           

Use this form when obtaining and documenting informed consent from a subject who does not speak English

Short form consent-Chinese        

Use this form when obtaining and documenting informed consent from a subject who does not speak English

Short form consent -Khmer

Use this form when obtaining and documenting informed consent from a subject who does not speak English

Short form consent-Hindi

Use this form when obtaining and documenting informed consent from a subject who does not speak English