PI Name:
Protocol #:
APPENDIX H. EXEMPTION OF STANDARDS REQUEST
Refer to Exemptions from Standards of Care for further guidance when completing this appendix.
An exemption occurs when deviating from the federal regulations and University policies and guidelines
regarding the care and use of vertebrate animals in testing, research and educational activities. A request
for an exemption must be submitted to the IACUC for review.
What is the purpose of an exemption?
To justify, based on scientific necessity or, in the case of husbandry, veterinary assessment, any deviations
from the Animal Welfare Act, the Guide, and other regulations in accordance to our IACUC Policy for
Exemptions from Standards of Care.
A consultation with an ACO veterinarian is required prior to completing this form.
So, what does the IACUC expect?
 A detailed description of the deviations from the Standards of Care outlined in the Guide. Include the
time period for how long this will apply to a given animal.
 An estimate of the numbers of animals which will be covered by the exemption. If circumstances
require a change in this number, an amendment to change this number will need to be submitted for
IACUC approval.
 A strong scientific justification for why no existing standard of care is acceptable; or in the case of
husbandry considerations, an unequivocal veterinary assessment of the appropriateness of the
proposed standards of care. Note that mere convenience or cost alone does not provide adequate
scientific justification.
Note that the exemption will be observed every 6 months during the Animal Facility Inspection, and
reviewed annual with the annual renewal of the protocol.
The IACUC approved exemptions must be posted in the animal facility for as long as the exemption is
active.
Veterinarian Contacts:
Dr. David Brammer, Executive Director ACO
Dr. Angelina Williams, Clinical Veterinarian
Dr. Terry Blasdel, IACUC Veterinarian
(713) 743-9164
(713) 743-2971
(713) 743-9191
IACUC Office Contacts:
Sarah Viranda, IACUC Coordinator
(713) 743-9252
DOR.ORPCC.A.0H - IACUC NP Appx H Exemption of Standards
Form updated March 2015
1 of 2
1. Location
Indicate the facility, building, and room number in which the exemption will take place:

2. Animal Use
For each animal or study group requiring this exemption, identify the specific group and indicate the
number of animals involved:

3. Exemption
Select which standard or guide you wish to have an exemption:
Food/water control (See Food and Water Restriction Policy)
The exercise plan for dogs
The environmental enrichment plan for nonhuman primates
Use of an animal in more than one major survival surgery
Maintaining animals at temperatures or humidities outside the ranges specified by standards
Cleaning or sanitation requirements
Diurnal light cycle requirement
Space requirement (including innovative enclosures and metabolic cages)
Other:
(e.g. federal, state, UH ACO guidelines)
4. Justification for Exemption
Explain why you need to deviate from the standards and derive the duration of the exemption (e.g.
weeks, year, permanent)

5. Distress
How is this experiment expected to increase stress in the animal and what are the plans to relieve
this stress?

6. Statement of Agreement
I have acquainted myself with the Federal Regulation and University Policies regarding the care and
use of vertebrate animals in testing, research and education activities. I am requesting an IACUC
exemption for the standards or guidelines listed above. If the exemption is granted, I am aware that
is exemption may be reported to the USDA and/or OLAW as required by law.
Signature of Principal Investigator:
Date:
DOR.ORPCC.A.0H - IACUC NP Appx H Exemption of Standards
Form updated March 2015
2 of 2