Texas Woman's University Institutional Review Board
Request to Initiate Institutional Authorization Agreement (IAA)
An IAA is a written agreement prescribed by OHRP that describes the obligations of both parties when one
relies on the other for IRB review and continuing oversight of one or more human subject research projects.
IAAs must be approved by the signatory officials of each institution. In order to request that the TWU rely on
another institutional IRB review and approval for a specific study, an investigator must complete this form,
obtain necessary signatures, and forward the signed form to the Office of Research & Sponsored Programs
at research@twu.edu. Detailed information regarding the IAA process can be found in the IRB Procedures.
TWU Principal Investigator (PI) Information:
Phone:
Name of PI:
Status:
faculty
student
staff
other :
E-mail:
Department:
Colleague ID# (this is the 7-digit # on your ID):
If the PI is a student, provide the following information for the faculty advisor:
Name of Advisor:
E-mail:
TWU Department:
Project Information:
Title of Study:
Estimated beginning date of study:
Campus (Denton, Dallas, or Houston)
Type of Project :
(check all that apply)
Estimated duration of study
Select One
thesis
faculty research
Level of review:
professional paper
pilot
exempt
dissertation
other
expedited
full
class project
Reviewing IRB Information (if needed, contact the Office of Research for assistance):
Name of the IRB Reviewing the Protocol:
Federalwide Assurance # of IRB:
Contact Person for IRB (provide name and
email or phone #):
Name & title of PI on other IRB application:
June 2015
1
Other Information:
IRB Approval Date:
Explain the TWU investigator’s role on the project and relationship or affiliation with the other institution.
Explain whether or not any part of the subject recruitment and data collection will be done on the TWU
campus. Typically, IAAs are only used when the study is being conducted at a non-TWU site.
List the TWU research team members other than PI and advisor (attach additional pages as needed):
Name
TWU 7-digit Colleague ID # (if applicable)
Email Address:
TWU Department
Role on Project
Name
TWU 7-digit Colleague ID # (if applicable)
Email Address:
TWU Department
Role on Project
Attachments (as applicable):
Attached
N/A
Approval letter from other institution’s IRB (required)
Protocol
Consent form
Current training certificate for TWU investigator if a current certificate is not already on file with
the IRB
Current training certificate for other TWU research team members if a current training
certificate is not already on file with the TWU IRB
Other (
)
Other (
)
Provide the IRB with any other information necessary for the review of this study.
June 2015
2
Signatures (Approvals):
TWU Principal Investigator (PI): Signature certifies that the investigator has primary responsibility for all aspects of the
research project.
____________________________________________________________
Principal Investigator
________________
Date
TWU Faculty Research Advisor (for student research only): Signature certifies that the faculty member has read,
reviewed, and approved the content of the application and is responsible for the supervision of this research study.
____________________________________________________________
Faculty Research Advisor
________________
Date
TWU Academic Administrator: Signature certifies that the administrator has read, reviewed, and approved the content
of the application.
____________________________________________________________
Academic Administrator (Department Chair, Program Director, or Associate Dean)
________________
Date
Once the above signatures have been obtained, forward the signed form with applicable attachments to the
Office of Research & Sponsored Programs (ORSP) via email to research@twu.edu. The staff in ORSP will
acknowledge the receipt of the request and begin working with the TWU PI and the other institution to
facilitate the IAA.
----------------------------------------------------------------------------------------------------------------------------------------------------------Office of Research & Sponsored Programs:
IRB Chair: Signature indicates agreement that an IAA is appropriate for this study and defers review and approval of
this study to the IRB named on the cover page.
____________________________________________________________
IRB Chair
________________
Date
Office of Research & Sponsored Programs (ORSP): Signature indicates that ORSP is in agreement with the IRB
chair and agrees that an IAA is appropriate for this study.
____________________________________________________________
Director of Operations, Office of Research & Sponsored Programs
June 2015
________________
Date
3