TTUHSC INSTITUTIONAL RECOMBINANT DNA BIOSAFETY ANNUAL REPORT
RENEWAL/AMENDMENT/TERMINATION
For Review by the Recombinant DNA Biosafety Committee (RDBC)
(Supporting NIH Reference Source: http://osp.od.nih.gov/office-biotechnology-activities)
Please complete form and send to sara.grano@ttuhsc.edu, Research Integrity Office, Lubbock.
This protocol expires
. Return this form by
.
PRINCIPAL INVESTIGATOR:
CAMPUS:
SCHOOL:
DEPARTMENT:
PHONE NO.:
FAX NO.:
E-MAIL:
PROJECT TITLE:
RENEWAL: Check only for the annual renewal of a currently active Registration. List the active
OSP Registration Protocol Number
.
AMENDMENT: Check only for an amendment of a currently active Registration. List the active
OSP Registration Protocol Number
.
TERMINATE: Check only for the termination of a currently active Registration. List the active
OSP Registration Protocol Number
.
LIST DETAILS BELOW OF CHANGES FOR A RENEWAL, AMENDMENT OR A TERMINATION
CHANGE: Materials or Procedures Involved in this Project
Delete:
Add:
CHANGE: Personnel Involved in this Project
Delete:
Add:
CHANGE: Location of Work Performed in this Project
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Add:
Principal Investigator Signature
DO NOT WRITE BELOW THIS LINE – FOR RDBC COMMITTEE USE ONLY
PROTOCOL NUMBER:
DATE RECEIVED BY RDBC:
APPROVAL AND MINIMUM BIOLOGICAL AND PHYSICAL CONTAINMENT REQUIRED FOR THE
TTUHSC PROPOSED STUDY UNDER NIH GUIDELINES RECOMBINANT DNA RESEARCH
_____ EXEMPT from current NIH guidelines
_____ Physical containment required: _____
_____ NONEXEMPT from current NIH guidelines
_____ Biological containment required: _____
CONTINUING REVIEW DUE: _________________ _____________________________________________
(Form Revised: 4/14)
(approximately)
Signature of Authorized RDBC Representative
Date Approved