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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.

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.

**The following "FORMS" are embedded in the Electronic Submission System (eIRB) as smart forms:

  • Initial Review Form (HRP-200)
  • Continuing Review Form (HRP-202)
  • Modification Form (HRP-203)

Non-UMass Personnel List

Use this form to report personnel outside the University of Massachusetts who are not listed in the eIRB system and who are not covered under their Institution's IRB.

Be sure the new staff fit a role described in the Investigator Study Plan. E-mail the Non-UMass Personnel list with the following to

  • Explanation of which staff are being added and/or deleted from an existing HRP-215 form
  • Copies of CITI Training Certificate(s) with UMass Worcester affiliation
  • Attestation that individuals are agents of UMass Worcester; for example, have gone through Volunteer Services or Human Resources, are paid by UMass Worcester, or are part of a recognized UMass program (e.g., Summer Undergraduate Research Opportunity). Or, a statement listing the person's home institution and whether or not an IRB Authorization Agreement is in place.
  • An evaluation of any positive declaration of a Related Financial Interest

External IRB Review Application

Use this form if you are requesting UMMS to serve as a Relying IRB 



Investigator Study Plan Template with Instructions

Use this template to develop the Investigator Study Plan. Instructions are included within the document.
Updated 3/15/2021

Request for Not Human Subject Research Determination

Use this document if you are seeking a written determination that your activity is Not Human Subjects Research or you are unsure as to whether your quality improvement/assurance project, program evaluation, or other activity requires IRB review.

Consent Form Template

Use this document to create the consent form for your research.
Updated 12/21/2020

Assent Template

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

Fact Sheet

Use this document when the study is no more than minimal risk (e.g., simple blood draw, survey, focus group) and when you are requesting a waiver of written documentation of consent.
Updated 12/21/2020

HIPAA Authorization

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

Need some clarity on HIPAA Authorizations? Click here to see the presentation slides on "HIPAA and Research"

HIPAA Waiver

Use this form when requesting a waiver of HIPAA authorization.

Click the link below to access the Accounting for Disclosures forms, which must be completed when a HIPAA waiver is granted.

Need some clarity on HIPAA Waivers? Click here to see the presentation slides on "HIPAA and Research"

Authorization to Contact 

Complete this form if you would like someone to contact you about the Research. Updated 12/21/2020

Short Forms: 

Select the preferred form below when obtaining and documenting informed consent from subjects who do not speak English.

**Note: Non-English speaking subjects can only be enrolled into a Research Study if this is indicated in the approved Investigator Study Plan. Contact the UMMS IRB for a copy of the Certification of translation


For studies approved prior to 1/21/2019  


For studies approved after

**Compliments from the University of Southern California**

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