Western IRB (WIRB) Forms

NOTE (6/1/09): Submission of Unanticipated Problem reports to WIRB. See the following link on the WIRB site regarding how and whether adverse events are reported to WIRB:
Unanticipated Problem Reporting Updated - March 2009

NOTE (6/1/09): Submission to Western IRB – The Office of Sponsored Programs – Industry Support requires two complete submission packages (one for WIRB and one for VCU) and a third abbreviated package for our files. The VCU COI forms are to be submitted for review at the time of IRB submission. These forms are reviewed by the VCU Conflict of Interest Committee, whose findings are communicated to WIRB. WIRB continues to evaluate COI concerns from the perspective of human subject protections. Please refer to the checklist - http://www.research.vcu.edu/forms/WIRB_checklist.doc - for the VCU COI forms and other submission information.

NOTE:  Until further notice, the following industry-sponsored projects (normally submitted to Western IRB) must be submitted to the VCU IRB:
Projects that meet one or more of the following criteria:

• involve human subject activities conducted by Navy and Marine Corps personnel;
• involve naval military personnel and Department of Navy (DoN) employees as research subjects;
• are supported by naval activities through any agreement (e.g., contract, grant cooperative agreement, development agreement [CRADSs], or other arrangement), regardless of the source of funding, funding appropriation, nature of support, performance site, or security classification; or
• are using DoN property, facilities or assets

All New Project Submissions (original, one complete copy, and a condensed copy) must be submitted to and signed off by the VCU Office of Industry Partnerships (OIP) before they are delivered to the VCU Office of Research Subjects Protection (ORSP). A complete checklist of documents that must be submitted to WIRB, ORSP and OIP can be found at http://www.research.vcu.edu/forms/WIRB_checklist.doc

     VCU Office of Sponsored Programs
     800 East Leigh Street, Suite 113
     Box 980568
     Richmond VA 23298

     VCU Office of Research Subjects Protection (ORSP)
     800 East Leigh Street, Suite 114
     Box 980568
     Richmond, VA 23298

All other submissions can be made directly to Western IRB; however, ORSP must receive one copy of all such submissions.

     Western IRB
     P.O. Box 12029
     Olympia, Washington, USA 98508-2029

Be aware that WIRB updates its submission forms as much as twice yearly to improve the review of research and protection of human subjects. When preparing to submit research for review, please be sure to use the most current versions of WIRB submission forms by referring to this website and linking to the forms below.

WIRB Fee Schedule (New rates effective 6/1/09)
WIRB Fee Schedule for Multicenter Studies (rates effective 6/1/09)
WIRB Consent Template
DNA Consent Addendum
Initial Review Cover Letter
Initial Review Submission Form
Investigator Submission Form for Multi-Center Trials – should be used by investigators participating in multi-center protocols for which the protocol has already been reviewed by WIRB
Change in Research Submission Form
Study Reporting Cover Letter
Subject Recruitment Submission Form
Protocol Deviations/Violations Reporting
Unanticipated Problem Reporting Forms
HIPAA Partial Waiver of Authorization
HIPAA Full Waiver of Authorization
Study Closure

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