PRACTICE Human Subjects Transmittal Form

PRACTICE
Human Subjects Transmittal Form

[When completed, this form will be emailed to the PI and to the faculty supervisor]

Principle Investigator's full name:

Principle Investigator's Official Oswego e-mail address:

Title of Investigation:

If appropriate, Faculty Supervisor's name:

Faculty Supervisor's Official Oswego e-mail address:

Yes No

1. The attached application involves scientific investigation using human subjects and I have completed the mandatory training within the past two years.

2. The attached application uses human subjects below the age of 18. If yes, this must be discussed in the protocol and parental informed consent or consent of the subject’s legally authorized representative must be obtained in addition to the informed consent of the minor.

3. The attached application involves experimental biomedical procedures, or use of drugs or toxic substances.

4. The attached application involves the administration of questionnaires, inventories or personality tests.

5. It is affirmed that the investigation will adhere to the policies and Procedures of the State University of New York for the study of human subjects.

6. Additions to or changes in procedures involving human subjects that occur after review of the application will be brought to the attention of the review committee as will anticipated problems involving risks to subjects or others.

Human Subjects Transmittal Form Research Protocol

A. Brief description of the research (e.g, purpose, hypotheses). 700 characters (about 125 words) max:

Characters typed:

B. A description of the benefits of the research to the human subjects, if any, and of the benefits to human or scientific knowledge. 700 characters (about 125 words) max:

Characters typed:

C. Description of subjects, indicating especially whether any are minors or otherwise members of vulnerable populations (e.g., subjects under the age of 18, pregnant females, prisoners). 800 characters (about 150 words) max:

Characters typed:

D. Description of how the subjects will be used (e.g., how they are selected, what they will do - such as complete questionnaires or participate in a simulated task). 500 characters (about 90 words) max:

Characters typed:

E. Description of the risks and discomforts, if any, to subjects. 400 characters (about 75 words) max:

Characters typed:

F. Does the proposed research involve deception, e.g., through provision of misinformation, withholding information, etc.? Explain why it is necessary to involve deception in the research. How will the subject be debriefed so as to minimize risk to the subject due to the deception? 500 characters (about 90 words) max:

Characters typed:

G. Upload your NIH Certificate, the Informed Consent Form, followed by any surveys, questionnaires or other material that involves the subject. Please upload only Word, .rtf, or .pdf files.

Before submitting this form, please review your entries to ensure that you have

entered your name and official Oswego email address
entered your faculty sponsor's name
correctly chosen yes/no for the six submission questions
entered text into each of the boxes A through F
uploaded a copy of your NIH certificate
uploaded the subject's Informed Consent form
uploaded an Informed Consent form for parents if the subject is a child
uploaded a Debriefing document
uploaded any surveys or other instruments the subjects will complete

To submit this form, please click on the following

[Revised February 5, 2010]

Yes	No
		1. The attached application involves scientific investigation using human subjects and I have completed the mandatory training within the past two years.
		2. The attached application uses human subjects below the age of 18. If yes, this must be discussed in the protocol and parental informed consent or consent of the subject’s legally authorized representative must be obtained in addition to the informed consent of the minor.
		3. The attached application involves experimental biomedical procedures, or use of drugs or toxic substances.
		4. The attached application involves the administration of questionnaires, inventories or personality tests.
		5. It is affirmed that the investigation will adhere to the policies and Procedures of the State University of New York for the study of human subjects.
		6. Additions to or changes in procedures involving human subjects that occur after review of the application will be brought to the attention of the review committee as will anticipated problems involving risks to subjects or others.