sIRB Intake Form
Purpose of the form
If you are requesting UF IRBs to serve as a single IRB of record for a multicenter study, please fill out the following form and submit along with the request to meet with the Reliance Team via the
IRB Contact Form
.
Upon receipt of the form, IRB staff will reach out to you to schedule a meeting with the Reliance Team that meets on Tuesdays 8:30 a.m. – 11 a.m.
Contact Details
First Name
Last Name
Email
UFID
Details
Study Title
UF PI Name
UF Lead Coordinator
Funding Agency
Status of the Award/Expected IRB Approval Date
Number of Sites
If known, names of the Institutions Involved
Brief Study Description
Risk
GMR
MR
Banking?
Yes
No
Is the banking local?
Yes
No