Institutional Review Board (IRB)
Office of Regulatory & Research Compliance
MSC 309 - (Phone) 437-3850 (Fax) 437-3855
orrc@albany.edu
Version 11.01.13.
SENSITIVE TOPICS SUCH AS SEXUAL BEHAVIOR, ILLEGAL CONDUCT, HIV/AIDS STATUS,
GENETIC INFORMATION, ALCOHOL OR ILLEGAL DRUG USE
(DO NOT LEAVE ANY QUESTIONS BLANK, INDICATE N/A WHEN NECESSARY)
1. Indicate the topic(s) that will be investigated in your research:
2. Indicate the risks to participants if this information became known outside of the
research setting:
3. Describe any extra precautions that will be used in this research to protect the
participants’ confidentiality:
4. Has a Certificate of Confidentiality been applied for?
Yes
No
Note: For certain research involving sensitive topics, the IRB may require you to apply for
Certificate of Confidentiality before approval is granted.
From the National Institutes of Health, Office of Intramural Research website:
Certificates of Confidentiality are issued by the National Institutes of Health (NIH) to protect identifiable
research information from forced disclosure. They allow the investigator and others who have access to
research records to refuse to disclose identifying information on research participants in any civil, criminal,
administrative, legislative, or other proceeding, whether at the federal, state, or local level.
Certificates of Confidentiality may be granted for studies collecting information that, if disclosed, could have
adverse consequences for subjects or damage their financial standing, employability, insurability, or
reputation. By protecting researchers and institutions from being compelled to disclose information that
would identify research subjects, Certificates of Confidentiality help achieve the research objectives and
promote participation in studies by assuring confidentiality and privacy to participants.
(Please consult with the Office of Regulatory & Research Compliance for guidance.)
The link to the application information may be found at the National Institutes of Health,
Office of Intramural Research Certificate of Confidentiality Kiosk at:
http://grants.nih.gov/grants/policy/coc/index.htm
5. Include additional information, data or comments that you feel are necessary to be
considered when evaluating your proposal.
1