Version Date: 4/2/03
IRB Authorization Agreement
Name of Institution or Organization Providing IRB Review (Institution A):
___________________________________________________________________________________
IRB Registration #: __________ Federalwide Assurance (FWA) #, if any: ___________
Name of Institution Relying on the Designated IRB:
University of Colorado at Boulder (UCB) OHRP Federalwide Assurance (FWA) # 00003492
The Officials signing below agree that UCB may rely on the designated IRB for review and continuing
oversight of the project described below:
Name of Research Project:
Name of University of Colorado at Boulder Principal Investigator:
Sponsor or Funding Agency: ________________ Award Number, if any: ___________________
The review and continuing oversight performed by the designated IRB will meet the human subjects
protection requirements of UCB’s OHRP-approved FWA. The IRB at Institution A will follow written
procedures for reporting its findings and actions to appropriate officials at UCB. Relevant minutes of
IRB meetings will be made available to UCB upon request. UCB remains responsible for ensuring
compliance with the IRB’s determinations and with the terms of its OHRP-approved Assurance. This
document must be kept on file at both institutions and provided to OHRP upon request.
Signature of Signatory Official (Institution A): ____________________________ Date: ___________
Print Full Name: ________________________________ Institutional Title: _____________________
Signature of Signatory Official (UCB): __________________________________ Date: ___________
Joseph G. Rosse, Ph.D., Associate Vice Chancellor for Research Integrity & Compliance