Request for Significant Change to Animal Use Protocol
Investigator/Instructor:
Campus Address:
Protocol #:
Title of Protocol:
Approved Project Dates:
to
Sponsored Project Title and Number:
Examples of Significant Changes requiring approval prior to implementation include a large change in numbers of animals being used or requested, an increase in
invasiveness, a change in species, an increase in pain or discomfort, or a change in the method of euthanasia. Check all that applies and provide detailed explanation,
including the scientific rationale, as it relates to the approved protocol. Be sure to describe what was previously approved as well as the requested change. Please refer
to the Animal Research Protocol Form, to determine the required information. Review for approval of this change may be performed via designated review or will
be at the next regularly scheduled meeting of the full IACUC committee (please protocol submission calendar on the IACUC web site).
Large increase in number of animals approved. If you increase the number of animals to be used, you must provide adequate
justification.
Major animal use procedures (i.e. method of invasiveness, surgery, etc)
Change in procedure that increase in pain or discomfort
Change in the method of euthanasia.
Other
Electronically submit this form and any accompanying documents to iacucsubmissions@umbc.edu. The Office for Research Protections and
Compliance prefers applications submitted in MS Word format, but Adobe Acrobat versions will be accepted also. Please be sure to include
the signature of the investigators. A scanned version as a PDF document is acceptable. If that's not possible, fax to (410) 455-3868.
Certification Statement
I certify that the original Project Review Form in conjunction with this Significant Change, accurately describes all aspects of the proposed animal usage. I further
certify that the use is not unnecessarily duplicative. I accept responsibility that all personnel working on the project will adhere to the regulations regarding the humane
treatment of laboratory animals and will receive proper training as required by the IACUC. I will obtain approval prior to instituting any other significant changes in the
project. I understand that the approval is not final until I receive notification of such in writing, and that the IACUC can require changes to the protocol. I understand
that approval of projects is for a maximum of one year from the date of IACUC approval of the original submission, and that approval of the significant changes
submitted on this form will not change the date of the annual renewal.
______________________________________________
PI Signature
___________________________________
Date
(IACUC USE ONLY - DO NOT WRITE BELOW THIS LINE)
Comments:_________________________________________________________________________________
__________________________________________________________________________________________
Review Date: ______________________________Date Approved by IACUC: ________________________
(Renewal date of protocol is not changed.)
IACUC Significant Change/Amendment Form– 12/07/2011
compliance@umbc.edu