CONTINUING RENEWAL REQUESTversion February 2025

CONTINUING RENEWAL REQUEST

version February 2025

IRBNet ID number and full study title*

Principal Investigator*

include credentials

study personnel*

Include name, credentials, department, and study role. Please also indicate additions and/or removals.

PI or designee email contact information*

The designee is the individual with knowledge about this project

Project type*

Select or enter value

Project Status*

Open to enrollment

Closed to enrollment

open to enrollment

Select or enter value

closed to enrollment

Select or enter value

Enrollment and study findings

This section will capture data from the last approval period as well as the overall study duration.

approved target number/charts

number of active participants

number of enrollees in last approval period

total enrollment to date

withdrawals in last approval period

Ethnicity breakdown to date

African American

American Indian

Asian

Caucasian

Latino

Native Hawaiian or other Pacific Islander

None

Other, specify

Vulnerable populations*

None

Cognitively impaired

Economically disadvantaged

Educationally disadvantaged

Pregnant women

Prisoners

Students

Employees

Other

recruiting and retention*

Explain any difficulties recruiting or retaining subjects, if applicable:

interim findings*

Describe any interim findings since the last review. Also, if the findings may affect a participant's willingness to continue in the research, please specify and indicate how participants were notified.

HUD/HDE Attestations

Patients received info sheet or brochure

Reportable events reported per policies

Medical device reporting per 21 CFR 803

Registry considerations

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attachments

Review list and be sure to include all relevant supplemental information in your submission request

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Send me a copy of my responses

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