Human Subjects
Protection Program
1618 E. Helen St.
P.O. Box 245137
Tucson, AZ 85724-5137
Tel: (520) 626-6721
http://orcr.vpr.arizona.edu/irb
HSPP Correspondence Form
Date: 04/24/12
Investigator: Dawn H. Gouge, B.Sc., Ph.D.
Department: Maricopa Agriculture Center
Project No./Title: 12-0161-00 Bed Bugs – Their significance as stressors, and reactive, harmful pesticide use
patterns
Current Period of Approval: 04/24/12 – No Expiration
Administrative Action
FWA Number: FWA00004218
IRB Committee Information
Administrative Review – New Project
Documents Reviewed Concurrently
F200: Application for Human Research (signed 10/12/11; re-signed 04/14/12; revised 04/18/12)
Consenting Instruments:
Disclosure (version 04/14/12)
VOTF (version 04/14/12)
Recruitment Materials:
Flyer- Online & Handout
Script
Data Collection Instruments:
Questionnaire
Other (define):
CV- Gouge
COI Determination
Determination
Approved as submitted effective 04/24/12
Comments
Foreign language translations of any written material to be provided to or meant to be seen or heard by
subjects must be submitted for review and approval prior to use.
Attached are stamped approved consent documents. Use copies of these documents to document
consent.
Requirements
Recruitment Site Authorization Requirement: Before posting any flyers/advertisements on private bulletin
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boards OR University of Arizona bulletin boards outside of the Principal Investigator’s home department OR physically
recruiting from any location, written site authorization must be obtained. Please retain this authorization in your research
records.
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Regulatory Determination(s)
Exempt Approval 45 CFR 46.101(b)(2): Research involving the use of educational tests (cognitive, diagnostic,
aptitude, achievement), survey procedures, interview procedures or observation of public behavior.
04/24/12
Sheryl Wurl, PhD
Date
Reminders: No changes to a project may be made prior to IRB approval except to eliminate apparent immediate hazard to subjects.
T106: HSPP Correspondence Form
Arizona’s First University – Since 1885
Form version: 01/19/2012
Dawn H. Gouge
12-0161-00
Page 2
Chair Designee, IRB2 Committee
UA Institutional Review Board
SW:ae
cc: Al Fournier
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No changes to a project may be made prior to IRB approval except to eliminate apparent immediate hazard to subjects.