Institutional Review Board
(IRB)
Office of Regulatory & Research Compliance
MSC 309 - (Phone) 437-3850 (Fax) 437-3855
orrc@albany.edu
Version 11.01.13
ELECTRONIC / ON-LINE DATA COLLECTION
Do not leave any questions blank; indicate “N/A” when necessary
NOTE: This form must be used for any type of on-line or electronic data collection involving interaction with any human
subjects, including when the research subjects are in the same room with the researchers. For guidance see the “Institutional
Review Board Electronic Data Management Policy”, “Standards for Connecting Servers to the University Network” and
“Protection and Use of Faculty, Staff and Student Identifiers”.
1.
Describe the type of research instrument subjects will be using. (e.g., survey, diary, behavior journal, etc.)
1-02. Indicate the medium by which the data will be collected.
: Publicly Accessible Internet Site
: Non-Public Internet Site*
: E-Mail
: Other (Specify):
: Database
*Requires an authentication method to gain access. i.e., social media or private forum
Researchers who manage, own her or operate their own server systems on the University’s network must submit
Supplemental Form 16-A.
2.
Will the investigator be in the same location with the subject while the subject completes the on-line survey or form?
Yes
No
[The login procedure may be accomplished either manually (using an ID and password) or automatically (using an individualized link sent in an invitation
e-mail).]
-
If YES, will the data collection tool include time and date fields that would allow the investigator to identify the
subjects?
Yes
No
-
If YES, describe the measures to be taken to maintain subject anonymity and/or confidentiality.
3.
Will the data collection tool require a login procedure for subjects?
Yes
No
If YES, will the survey data set include “pre-populated” data fields from the respondent database?
Yes
No
-
4.
If YES, specify what data fields will be included in the data set (this would include identifiers or e-mails addresses if
they are inserted into the data set automatically).
Will the electronic tool be used to collect and record subject consent?
-
Yes
No
If YES, describe how the electronic tool will be used to collect and record the data.
[Be sure to include a hardcopy of the informed consent form with the submission and request a waiver of the requirement to obtain signed
documentation of informed consent.]
5.
If using an external host, provide a link to the host’s security and privacy policy(ies) and describe any requirements
of the host which affect the appearance of the survey.
[Use this space to describe any banner ad, logo or thank you page requirements. All reasonable efforts should be made to minimize or eliminate
commercial instruments not specifically part of the research shown to participants.]
6.
If using an external host, identify the account owner and the type of account (e.g., free, basic, professional etc.) that
will be used.
7.
Provide justification for any survey items indicated as “required,” rather than “voluntary,” for subjects to complete.
[This feature should be used only sparingly and only for an item that would if left unanswered render the tool useless in the research. The use of
required items should be viewed the same as it would for any survey, for which the presumption is that all items are optional.]
8.
Will the collected electronic data include any identifying information (such as e-mail address, name, phone number,
social security numbers, birth date, IP addresses) or any other data that by itself or in combination with other data
could be used to determine the subjects’ identities?
Yes
No
[This includes any data collected for the research or data collected to pay any offered incentive. Be sure to include a hardcopy of the data collection
screen that references the incentive.]
-
If YES, describe the data to be collected and all measures to be taken to protect subjects’ confidentiality.
9.
Describe any and all locations – whether virtual or physical – where electronic data will be stored, even temporarily
(this should include the host, any individual computer, any networks and any portable media). List any and all
persons with access to such locations. Describe the measures to be taken to protect the data (i.e., password
protection, pc login screens, etc.).
10.
Provide a link and any information needed to log in to a fully functional on-line version of the survey/form that will be used.
[No on-line tool will receive final IRB approval until an otherwise final on-line working version has been reviewed. Be sure to include a hardcopy of the
data collection tool as it appears on-line.]