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COVID-19 Witness Signature & Attestation Page

Version Date: March 30, 2020

VA Documents and Forms

Version Date: September 1, 2015

Recruitment Letter Template

Version Date: May 14, 2010

Full Protocol Documents

Version Date: October 17, 2024

Data Use Agreement (DUA) Template – IHC

Version Date: June 9, 2008

Agreement for Public Ethnographic Studies

Version Date: October 17, 2024

COVID-19 Person Obtaining Consent Attestation Page

Version Date: March 30, 2020

Research Consent Process Worksheet – Obtaining Signed Consent During the COVID-19 Pandemic

Version Date: March 30, 2020

Blank Watermark Document

Version Date: February 1, 2019

CTSI Consent Executive Summary Template (CTSI Document)

Version Date: July 12, 2021

Debriefing Document Template

Version Date: July 20, 2011

Pregnancy Follow-Up Consent and Release of Information Authorization Template

Version Date: April 21, 2021

Translation Certification Letter Template

Version Date: December 27, 2022

Signature Block Samples

Version Date: March 8, 2024

LAR Signature Page

Version Date: March 8, 2024

Witness Signature Page

Version Date: November 20, 2011

Utah Population Database (UPDB) Consent and Authorization Requirements

Version Date: February 1, 2011

Humanitarian Use Device (HUD) Informed Consent Checklist

Version Date: June 5, 2024

Expanded Access Informed Consent Checklist

Version Date: June 5, 2024

Emergency Use Consent and Authorization Document Template

Version Date: January 6, 2015

VA Emergency Use Consent Document Template

Version Date: August 17, 2015

VA Humanitarian Use Device (HUD) Consent and Authorization Document Template

Version Date: August 17, 2015

VA IRB Documentation of Waiver of HIPAA Authorization for Research

Version Date: July 1, 2011

VA Revocation of Authorization for Use & Release of Health Information Form 10-10116

Version Date: September 1, 2015

Simple Referral Template

Version Date: October 22, 2024

Data Use Agreement (DUA) Template – UUHSC

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Please contact Technology Licensing Office

Material Transfer Agreement (MTA) Template

Please contact Technology Licensing Office

Certification for Emergency Use of a Test Article without Informed Consent

Version Date: January 3, 2012

Case Report Using Existing Data Author Worksheet

Version Date: September 1, 2015

Data / Biospecimen Repository Management Plan Template

Version Date: February 18, 2022

Department of Defense (DoD) Supplement

Version Date: April 18, 2024

Exclusion of Research Data in EMR Request Form
Available on Pulse (University employee access only) University of Utah Health Form Only; This is not a requirement of all studies that use the University of Utah IRB.

Version Date: October 22, 2024

Payment Process Exception Request

Version Date: January 8, 2024

Privacy Protection Verification for Research Conducted in Schools

Version Date: August 15, 2017

Exemption Umbrella Annual Report Template

Version Date: September 1, 2013

Research Preparation Form

Version Date: July 21, 2014

Research Using Decedents’ Information Form

Version Date: October 23, 2013