Associate Provost’s Office 3/02
FOR rDNA OFFICE USE ONLY
rDNA Protocol #
 PI information
 Standard Continuation
 Follow-up
 Renewal Report

IBC1/RD
IBC2/RD
Carnegie Mellon University
Institutional Biosafety Committee (Recombinant DNA)
FORM rDNA-3
RENEWAL DOCUMENT FOR CONTINUING
RECOMBINANT DNA RESEARCH
Attention: DO NOT leave any blanks. Incomplete applications may require additional information and delay processing/review.
Please submit electronically via email attachment to sshingle@andrew.cmu.edu
DATE:
PRINCIPAL INVESTIGATOR:
TITLE OF PROJECT
IS THERE A CHANGE IN
INVESTIGATOR INFORMATION?:
If “YES” please fill out the New
Investigator information below:
If “NO” and the current information on
file for the Investigator has NOT changed,
skip to section 2
1. INVESTIGATOR INFORMATION:
DATE:
TITLE:
DEPARTMENT:
OFFICE (BLDG/ROOM):
OFFICE PHONE:
OFFICE FAX:
OFFICE STREET ADDRESS
OFFICE ZIP CODE
LABORATORY (BLDG/ROOM):
LAB PHONE:
E-MAIL:
ALTERNATE CONTACT PERSON:
CONTACT PHONE:
CONTACT E-MAIL:
2.
THE STATUS OF THIS PROTOCOL IS CURRENTLY: (check ONE)
[ ] Continuing rDNA Experiments/Intervention with NO changes
[ ] Closed to enrollment, protocol Follow-up Phase, NO Active rDNA intervention
[ ] Long-term Follow-up
PLEASE PROVIDE
A COPY OF THE IRB RESEARCH STUDY RENEWAL REPORT WITH ALL GENE TRANSFER
PROTOCOLS.
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Associate Provost’s Office 3/02
3.
RENEWAL CERTIFICATION
a.
I agree to conduct this project in accordance with the compliance policies of the Associate Provost’s
Office, Carnegie Mellon University Institutional Biosafety Committee, including all requisite training
of students, staff and other professionals participating in this project.
b.
I have consulted Section IV-B-7 of the NIH Guidelines which describes the responsibilities of the
Principal Investigator and hereby agree to comply fully with all provisions of the Guidelines. I
understand that I am responsible for assuring that my project areas are in compliance with all federal,
state, and local environmental laws and regulations.
c.
I understand that all changes in the research protocol (including changes in the source of DNA, hostvector systems, dosage ranges, laboratory room changes, etc.) or project participants must be reported
to the rDNA Office and all other university regulatory offices in connection with this protocol.
Modification requests forms are available at the Associate Provost’s Office, 412-268-4727 or email at
sshingle@andrew.cmu.edu.
d.
If funded by an extramural source, I assure that this application accurately reflects all procedures
involving Recombinant DNA as described in the grant proposal to the funding agency.
e.
The information within this application is accurate to the best of my knowledge.
f.
I understand that yearly renewal is required for continuing approved projects.
g.
I understand that notification applications and approvals must be resubmitted for committee review
after a term of three years.
h.
The electronic submission and acceptance of this document at the Associate Provost’s Office is
agreement with the statements a-g (above).
The Associate Provost’s Office and IBC in conjunction with the EHS Office reserve the right to conduct
inspections of the research facilities at any time.
Principal Investigator Name:
Signature:
Date of Application:
End of Application
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