Applications & Forms

• Application to Use Animals [Instructions]
• Annual Continuation Application
• Modification Application [Instructions]

• Appendix A: Three-Year Progress Report
• Appendix B: Create and Maintain a Breeding Colony
• Appendix C: Hazardous Materials
• Appendix D: Use of Prolonged Restraint
• Appendix E: Use of Paralytic Agents
• Appendix F: Multiple Major Survival Surgery
• Appendix G: Production of Antibodies
• Appendix H: Non-UCI Locations
• Appendix I: Investigator-Maintained Animals
• Appendix J: Request for Housing Exception
• Appendix K: Variations in Standard Housing or Husbandry

Not sure which appendices you need? See the protocol preparation checklist for details.

• Investigator's Assurance Statement
• Custom Antibody Production Contract Agreement
• Add Title or Funding Source
• University Laboratory Animal Resources Forms (UCInetiD required)

• Application for IRB Review [Instructions] — Updated April 2008
• Continuing Protocol Application
• Modification Application
• Adverse Events and Unanticipated Problems Updated October 2007
• Closing Report
• Document Depot

• Protocol Narrative [Instructions] - Updated December 2007
• Protocol Narrative for NCI CIRB Approved Studies [Instructions]
• Registration Form for Studies Approved under UC MOU
• Request for Determination of Non-Human Subjects Research Form


• Disclosure of Investigator's Financial Interests
• Investigator's Assurance Statement
• HIPAA Research Authorization for Release of PHI - 2004
• Standard UCIMC Research Recruitment Advertisement


• Self-Certification of Surrogate Decision Makers for Research Studies
• Decision-Making Capacity Assessment Tool - New


• Emergency Use: Permission for Emergency Use of Investigational Drug/Biologic/Device for Patient Care
• Emergency Use: Memorandum of Understanding Related to the Use of Data Obtained under Emergency Use Approval


• UCI Non Reportable Events Report - New
• Internal Unrelated SAE Summary Log - New

• Informed Consent Document Template (Biomedical)
• Informed Consent Document Template (Social-Behavioral)
• Informed Consent Document Template for Donation of Embryos
• Minor Assent Form Template
• Study Information Sheet
• Experimental Subject's Bill of Rights
• NCI CIRB Consent Form Check List for UCI Required Additions
• PET Addendum Consent Template
• Emergency Use: Consent to Undergo Emergency Treatment with Investigational Drug/Biologic/Device
• Humanitarian Use Device – Informed Consent Template

• Self-Certification of Surrogate Decision Makers for Research Studies (Spanish)
• Authorization for Release of PHI for Research Purposes--2004 (Spanish)
• Authorization for Release of PHI for Research Purposes--2004 (Vietnamese)
• Subject's Experimental Bill of Rights (Chinese)
• Subject's Experimental Bill of Rights (Farsi)
• Subject's Experimental Bill of Rights (Korean)
• Subject's Experimental Bill of Rights (Spanish)
• Subject's Experimental Bill of Rights (Tagalog)
• Subject's Experimental Bill of Rights (Urdu)
• Subject's Experimental Bill of Rights (Vietnamese)

Note: Only UCI IRB-apporved (stamped) short form consents may be used to consent potential research participants

• English Short Form Consent (for viewing and translation purposes)
• Spanish Short Form Consent
• Vietnamese Short Form Consent
• Chinese Short Form Consent
• Korean Short Form Consent
• Farsi Short Form Consent

• Checklist for Exempt Research
• Checklist for Expedited Research
• Checklist for Full Committee Research
• Checklist for Continuing Review
• Checklist for Modification/Amendment Requests