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Many of WIRB's Word-format submission forms are now retired and replaced with dynamic, PDF-based submission forms!   

New pdf-based smart forms are now available below for sending initial reviews, changes in research, promptly reportable information, and study closure information.

Please note the following about our improved forms:

  • The smart forms must be completed using either Adobe's free Reader or Adobe Acrobat (version 9.1 or newer). Use of a program other than Adobe (version 9.1 or newer) to view or complete the forms will result in missing questions and non-functional fields.  To download Adobe Reader for free, please visit https://get.adobe.com/reader/. (If you do not have access to Adobe's Reader or Acrobat, you may continue to submit the Word-format forms. In 2016 we will be making available an html5  [online] version of the forms that do not require Adobe software.)  
  • Because these smart forms are dynamic (change based on your responses), they must be completed electronically; therefore, you cannot print them out and complete them on paper. However, at any time during their completion, you can edit, save, print, or share with your colleagues.
  • We will continue to accept the old forms until October 3, 2016 (period extended).
  • The new forms have been adopted by both WIRB and CGIRB -- the smart pdf forms below can be submitted to either WIRB or CGIRB.

A brief orientation and tutorial on the new forms is available here:  http://www.cgirb.com/wp- content/uploads/2015/12/WCG-SMART-Forms-Training-Guide.pdf 

The forms below provide WIRB with all the required IRB review information required.  Please provide a submission form with each protocol you submit for review. 

For questions or assistance, please see the WIRB Guide for Researchers available below, call 1-800-562- 4789, or email clientservices@wirb.com.

New Studies
Name

Version Number
Release Date

Fillable
 Word
Adobe PDF
WIRB Investigator Handbook "A Guide for Researchers" 08/03/2016 PDF
Investigator Guidance (Sample SOPs) Moved to Miscellaneous Resources Tab

Initial Review submission Form

2.0.1
09/23/2016

Smart PDF
Right-click the link and select 'Save Target As' or 'Save Link As' to download the file, and open the destination folder to open the form

Financial Interest Disclosure Form 10/01/2009 Word
Initial Review Submission Form for International Sites 09/25/2015 Word
Request for Exemption Determination 01/06/2016 Word
Request for Exemption Determination - Canada 01/06/2016 Word
Single Patient Expanded Access Submission Form 07/13/2016 Word
New Jersey Requirements for Inclusion of Decisionally Impaired Subjects (New Jersey Statute 26:14-5) 05/14/2012r1 Word
Request for a Partial Waiver of Authorization for Recruitment (HIPAA Partial Waiver of Authorization) 12/15/2015 Word
Request for Full Waiver of Authorization under HIPAA 12/15/2015 Word
IRB Transfer Cover Letter Checklist & Summary Form 09/19/2016 Word
Waiver of Consent Request for In Vitro Diagnostic Device Studies Using Leftover Human Specimens That Are Not Individually Identifiable 09/28/2006r2 Word
Sample IRB Authorization Agreement (with WIRB filled in as institution A) 03/31/2011 Word
Addendum for Department of Defense Funded Research 06/03/2016 Word
Locations With Obligations to other IRBs - Dual Oversight - US Site 06/30/2016 Word
Locations With Obligations to other IRBs - Dual Oversight - Canadian Site 06/30/2016 Word
Locations With Obligations to other IRBs - Split Oversight 06/30/2016 Word
Locations With Obligations to other IRBs - Split Oversight - Canadian Site 06/30/2016 Word
Locations With Obligations to other IRBs - Waive Oversight to WIRB 06/30/2016 Word
WIRB Consent Form Template 06/15/2015 Word
Pregnant Partner Template Consent Form (pregnant partner information release form ) 10/07/2014 Word
Pregnant partner information release form signature page addendum – for pregnant partners who require a legally authorized representative 06/17/2016 Word
Template Information Sheet for Waiver of Documentation of Consent 07/24/2014 Word
Single Patient Expanded Access Consent Form Template 12/07/2015 Word
Retired: Additional Sites Page (Initial Review)
This form has been folded into the new smart initial review submission form
07/2012r1 Retired
12-21-2015
Retired: Annotated Initial Review Submission Form 07/2012 (rev 08-2015)
Retired
12-21-2015
 
Retired: Investigator Submission Form for Multi-Center Protocols
This form has been folded into the new smart initial review submission form
07/2012r4
Retired
12 -21-2015
Retired: Initial Review Submission Form for Sponsors and CROs
This form has been folded into the new smart initial review submission form
07/2012r4
Retired
12 -21-2015
Retired: HUD On-Label Use Submission Form
This form has been folded into the new smart initial review submission form
02/06/2013r2
Retired
12 -21- 2015 

Studies in Progress
Name Version Number
Release Date
Fillable
Word
Adobe PDF
Change in Research Submission Form
2.0.0
08/19/2016

Smart PDF
Right-click the link and select 'Save Target
As' or 'Save Link As' to download the file, and open the destination folder to open the form
 

Promptly Reportable Information Form
2.0.0
08/19/2016
 

Smart PDF
Right-click the link and select 'Save Target
As' or 'Save Link As' to download the file, and open the destination folder to open the form
 

Translation Request Submission Form 05/16/2016 Word
Recruitment Bonus Disclosure Form 10/01/2009 Word
Impartial Witness Form for Limited and Non-Readers 02/10/2013 Word
Consent addendum for subjects originally enrolled as children who are now adults 01/19/2011 Word
California Experimental Subjects' Bill of Rights - WIRB simplified version negotiated with California AG office in 2007 2007 Word
Instructions for Notifying Subjects of WIRB's Move to Puyallup, Washington (Letter to subjects also available in Polish, Russian, Simplified Chinese, Spanish, Korean, Japanese, French, Armenian, Traditional Chinese and Vietnamese) 11/19/2013 Word
Emergency Use Post-Use Report Form 06/01/2015 Word
Contact Information Update Form 06/09/2015r1 Word
Retired: Change in Research Additional Sites Page
This form has been folded into the new smart change in research review submission form
01/12/2012r1 Retired
12-21- 2015
Retired: Screening Procedures Information Form 10/01/2009 Retired
12-21- 2015
Unanticipated Problems Reporting Form - Adverse Events  (Retired 02-25-2014, see Promptly Reportable Information Form replacement) 02/14/2014
Unanticipated Problems Reporting Form - Problems that are Not Adverse Events (Retired 02-25- 2014, see Promptly Reportable Information Form replacement) 02/14/2014
Non-Site Adverse Event Report Submission Form (Retired 02-25- 2014, see Promptly Reportable Information Form replacement) 07/17/2013

Continuing and Final Review
Name Version Number
Release Date
Fillable Word Adobe PDF
Study Closure Report Form
2.0.1
09/07/2016

Smart PDF
Right-click the link and select 'Save Target
As' or 'Save Link As' to download the file, & open the destination folder to open the form
 


Translated Short Forms for Consent 

(View an English version of this OHRP short form here: http://www.hhs.gov/ohrp/policy/ic-non-e.html#sample)

Name Version Date Word Adobe PDF
Albanian Short Form (Translation certification) 03/30/2016 Word
Arabic Short Form (Translation certification) 02/12/2014 Word
Armenian Short Form (Translation certification) 04/29/2013 Word
Cambodian Short Form (Translation certification) 05/05/2015 Word
Creole Short Form (Translation certification) 07/24/2014 Word
French Short Form (Translation certification) 04/29/2013 Word
Edo Short Form (Translation certification) 02/02/2015 Word
Greek Short Form (Translation certification) 06/27/2016 Word
Gujarati Short Form (Translation certification) 02/12/2014 Word
Hebrew Short Form (Translation certification) 12/29/2014 Word
Hungarian Short Form (Translation certification) 01/26/2015 Word
Italian Short Form (Translation certification) 06/12/2015 Word
Japanese Short Form (Translation certification) 04/29/2013 Word
Korean Short Form (Translation certification) 04/29/2013 Word
Russian Short Form (Translation certification) 04/29/2013 Word
Simplified Chinese Short Form (Translation certification) 04/29/2013 Word
Somali Short Form (Translation certification) 02/10/2016 Word
Spanish Short Form (Translation certification) 04/29/2013 Word
Traditional Chinese Short Form (Translation certification) 04/29/2013 Word
Turkish Short Form (Translation certification) 04/29/2013 Word
Urdu Short Form (Translation certification) 05/19/2016 Word
Vietnamese Short Form (Translation certification) 04/29/2013 Word
Yiddish Short Form (Translation certification) 04/29/2013 Word
 
Sending the forms to WIRB
Please complete and return your form(s) to WIRB via Connexus®, e-mail, fax, or postal mail.

WIRB
1019 39th Avenue SE Suite 120
Puyallup, Washington 98374-2115
USA
E- mail: clientservices@wirb.com
Fax: (360) 252-2498