IRB Form 3
Farmingdale State College
Institutional Review Board
Application for Determination of Exempt Status
(Form Approved: February 2007)
Date:
Does the research activity involve any of the following populations or categories of research:
Prisoners
Pregnant Women
Fetuses
In vitro fertilization
[If you checked any of the boxes above, your protocol is not eligible for exemption]
Principal Investigator:
Protocol Title:
In order to qualify for exempt status, the research must fall into one of the following categories.
Research conducted in established or commonly accepted educational settings, involving normal
educational practices such as:
● Research on the effectiveness of or the comparison among instructional techniques,
curricula, or classroom management methods
Research involving educational tests (cognitive, diagnostic, aptitude, achievement), survey
procedures, interview procedures, or observation of public behavior, where:
●
●
Information obtained is recorded in such a manner that human subjects cannot be
identified, directly or through identifiers linked to the subjects; and;
Any disclosure of the human subjects’ responses outside the research could not
reasonably place subjects at risk of criminal or civil liability or be damaging to the
subjects’ financial standing, employability, or reputation.
Research with children does not qualify under this category unless the research only involves the
observance of public behavior when the PI is an observer and NOT a part of the activity.
Research involving the collection or study of existing data, documents, records, pathological
specimens or diagnostic specimens, when these sources are publicly available or when the
information is recorded in such a manner that the subjects cannot be identified, directly or through
identifiers linked to subjects.
Final determination regarding exempt status will be determined by the IRB
Chair/designee. All research deemed exempt is subject to the same policies and
ethical principles governing all research at this institution.
_______________________________
Principal Investigator Signature
IRB Office Use Only:
Exemption Request: __ Approved __ Denied
__________________
Date
IRB Reviewer _________________________