University of the Virgin Islands
Research Involving Human Subjects Protocol Application
INSTITUTIONAL REVIEW BOARD FACE PAGE
P.I. Name:
Grant Award #:
Protocol Title:
Department:
Phone #:
Email:
(If applicable)
SECTION ONE: Expedited vs. Full Review
Does your research involve any of the following:
Does your research involve any of the following:
(Check all items that apply.)
YES
NO Prisoners
YES
NO The use of deception (the research subjects are
misled as to the nature of the research or their involvement in it.
YES
NO Gathering data that can be linked to (is identifiable
with) specific research subjects.
YES
NO Audio or video taping of research subjects.
YES
NO Recruitment of HIV positive individuals.
YES
NO Interactions with research subjects under the age of
18 outside the normal educational setting OR beyond the observation
of public behaviors.
YES
NO *The administration of non-standard, low-risk
educational tests or survey measurements to individuals under the
age of 18. (See NOTE below).
YES
NO The gathering of data relating to criminal behavior,
drug use, sexual habits or attitudes, or any other behaviors or
attitudes that, if tied to an individual research subject, could cause
harm to the subject or their reputation.
(Check all items that apply.)
YES
NO The collection or study of existing data,
documents, records, or pathological or diagnostic
specimens?
YES
NO The study, evaluation, or examination of
existing public benefit or public service programs?
YES
NO Research conducted in established or
commonly accepted educational settings involving standard
educational practices such as research on the effectiveness
of regular or special education instructional strategies, or a
comparison among instructional techniques, curricula, or
classroom management methods?
YES
NO *The use of standard, established, low risk
educational tests, surveys, or interview procedures. (See
NOTE below).
YES
NO Observed public behavior that does not
involve your direct interaction with individuals under the
age of 18 beyond the administration of surveys, tests, or
interview procedures?
If you answered “yes” to any of the above, your application will
receive full IRB Review.
If you checked “yes” to one or more of the questions
above, your application may receive expedited review.
*NOTE: If the test, survey, or interview procedure is developed as part of the research, or if the research is intended to validate the
measure, the test, survey, or interview procedure is not considered “established” or “standard”. If the survey or interview questions
relate to criminal behavior, drug use, sexual habits or attitudes, or any other behaviors or attitudes that, if tied to an individual
research subject, could cause harm to the subject or their reputation, or if the questions asked may cause distress to the research
subject, they are not considered “low risk.”
SECTION TWO: Protocol Information
TYPE OF APPLICATION
Initial
Annual Renewal
Revision
NOTE: It is your responsibility to notify the IRB of any proposed changes to an existing protocol. Any change to an existing
protocol must be approved by the IRB prior to its implementation. Annual review of existing protocols is required. Complete
documentation must be provided at the time of annual continuing review, protocol revision, or study termination.
For Official Use Only
Protocol #:
Initial Protocol #:
Exemption #:
(If Application is a renewal or revision)
(If approved by IRB Chair below.)
Type of Review Recommended to IRB Chair
Full IRB Review
Expedited Review to determine Exemption
Utilizing expedited review procedures, I have reviewed the Human Subjects Protocol Application attached to this face
page and all appended documentation and have determined that this research protocol is exempt from full IRB Review.
Signature:__________________________________________
Dr. Suzy Harney, IRB Chair
Office of Sponsored Programs
#2 John Brewer’s Bay, St Thomas, VI OO802
Tel: (340) 693-1176