Forms

Protocol Forms

Note: Before you submit any of the following applications to the IRB, you MUST certify. Certification can be obtained by taking the Online tutorial.

• Full Committee Review Application Form (DOC | RTF)
• Expedited Review Application Form  (DOC | RTF)
• Exemption Application Form (DOC | RTF)
• Progress Report (DOC | RTF)
  • Adverse Event Table for submission with the Progress Report and Study Closure Forms (DOC | RTF)
  • Deviations Table for submission with the Progress Report and Study Closure Forms (DOC | RTF)
• Permanent Closure of All Study Activities Form (DOC | RTF)
• Modification /Amendment Form (DOC | RTF)

Other Forms

• Sponsor Information Form for IRB Fees (DOC | PDF | RTF)
• Attestation Form (DOC | RTF)
  Submit this form with your NIH Certification to the IRB Admin office.
• Investigational Devices Record Form (DOC | RTF)
• Investigational Drug Information Record Form (DOC | RTF)
• Report of Adverse Events and Unanticipated Problems Involving Risk to Participants or Others (DOC | RTF)
• Protocol Deviations Form (DOC | RTF)

Consent Forms

• Standard Model Consent Form (DOC | RTF)
• Model Consent Form for Social and Behavioral Studies (DOC | RTF)
• Model Assent Form for Minors in Research (DOC | RTF)
• Joint VA-UCD Model Consent Form (DOC | RTF)
• VA-UCD HIPAA Research Authorization Form (DOC | RTF)
• Consent for the Use of Leftover Biological Specimens (DOC | RTF)
• This consent form is only for studies where the researcher is collecting normally discarded tissue removed from non-research related surgeries.
• The "Treatment Use of Investigational Drug or Procedure" model consent form has been removed from the website. To access this form, please contact the IRB Administration at 916-703-9151.

• Short Form
  English (reference only) (PDF)
  Spanish (PDF)
  Chinese (PDF)
  Hmong (PDF)
  Korean (PDF)
  Lao (PDF)
  Punjabi (PDF)
  Russian (PDF)
  Tagalog (PDF)
  Vietnamese (PDF)
  

Bill of Rights

• Bill of Rights - Medical Research Studies
  English (DOC | RTF | PDF)
  Spanish (DOC | PDF | RTF)
  Chinese (PDF)
  Hmong (PDF)
  Korean (PDF)
  Lao (PDF)
  Punjabi (PDF)
  Russian (PDF)
  Tagalog (PDF)
  Vietnamese (PDF)
  
• Bill of Rights and Instructions - Social and Behavioral Studies
  English (DOC | PDF | RTF)
  Spanish (DOC | PDF | RTF)
  Chinese (PDF)
  Hmong (PDF)
  Lao (PDF)
  Punjabi (PDF)
  Russian (PDF)
  Tagalog (PDF)
  Vietnamese (PDF)