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Administrative disclosure form issued by the Institutional Review Board of Blessing-Rieman College of Nursing and Health Sciences detailing required reporting of financial interests, relationships, and intellectual property associated with proposed research studies.
Institution:
Blessing-Rieman College of Nursing and Health Sciences
Department:
Institutional Review Board (IRB)
IRB Address:
13609 N. Marx Drive, Quincy, IL 62305
Document Type:
Administrative disclosure form
Subject:
Conflict of Interest (COI) disclosure for research studies
Applicable To:
Research studies and projects under IRB review
Submission Format:
Microsoft Word document
Submission Email:
[email protected]
Required Completion Method:
Typed form only
Sections:
General Information; Nature of the Conflict of Interest
Related Topics:
Financial interests, personal relationships, intellectual property, research sponsorship, commercialization
Geographic Location:
Quincy, Illinois, United States
Date:
September 2019
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2026
Region / City:
Global
Topic:
Conflicts of Interest (COI)
Document Type:
Guidance Document
Organization:
ILCOR
Author:
ILCOR COI Committee
Target Audience:
ILCOR participants, volunteers, staff, and other stakeholders
Period of Validity:
Ongoing
Approval Date:
Not specified
Amendment Date:
Not specified
Note:
Year
Region / city:
Great Britain
Theme:
Organic certification, import procedures
Document type:
Official form
Institution:
CERES
Author:
CERES
Target audience:
Exporters, importers, and traders in organic products
Note:
Year
Year:
2023
Region / City:
Oregon
Topic:
Conflict of Interest Disclosure
Document Type:
Disclosure Form
Organization / Institution:
Oregon Department of Transportation
Author:
Oregon Department of Transportation
Target Audience:
Firms under contract or proposing to enter into a contract with ODOT
Period of Effectiveness:
Ongoing
Approval Date:
Not specified
Date of Changes:
Not specified
Note:
Year
Year:
2023
Region / City:
N/A
Subject:
Conflict of Interest
Document Type:
Policy
Organization / Institution:
American Academy of Sleep Medicine (AASM)
Author:
N/A
Target Audience:
Board Members, Committee Members, Sleep Medicine Professionals
Period of Validity:
N/A
Date of Approval:
N/A
Date of Amendments:
N/A
Note:
Date
Subject:
Declaration of Conflict of Interest (COI) for Principal Investigator and/or Sub-Investigator
Type of document:
Declaration
Institution:
ST. CABRINI MEDICAL CENTER – ASIAN EYE INSTITUTE ETHICS REVIEW COMMITTEE
Target audience:
Ethics review committee members
Period of validity:
N/A
Date of approval:
N/A
Date of changes:
N/A
Year:
2023
Region / City:
Global
Topic:
Conflict of Interest Management
Document Type:
Guidelines
Organization:
ILCOR
Author:
ILCOR
Target Audience:
ILCOR Participants, Task Force Leaders, Committee Members
Effective Period:
Ongoing
Approval Date:
2023-01-01
Date of Changes:
None
Year:
2018
Month:
April
Topic:
Conflict of Interest disclosure management and review procedures
Document type:
Training exercises manual
System / platform:
COI Module (Click system)
Organization:
Research Foundation for SUNY
User roles referenced:
Principal Investigator, COI Discloser, COI Administrator, COI Committee Member, COI Monitor
Processes covered:
Disclosure submission, administrative review, ancillary review, committee meeting procedures, management/mitigation plan oversight
Content structure:
Step-by-step exercises with questions for system navigation and workflow practice
Primary activities:
Logging in, editing certifications, submitting disclosures, assigning committees, preparing agendas, convening meetings, recording decisions, correspondence preparation
System access reference:
https://pacsstg3.rfsuny.org
Year:
2026
Institution:
University of Kansas Medical Center (KUMC)
Document Type:
IRB Request Form / Research Protocol Submission
Target Audience:
Principal Investigators and Research Staff
Applicable Regulations:
45 CFR 46, 34 CFR 97, HHS Common Rule
Research Type:
Minimal Risk Behavioral and Biomedical Studies, Secondary Data Analysis
Submission Method:
myIRB Electronic Application
Required Materials:
Completed Form, Data Collection Sheets, Consent Forms, Recruitment Materials
Notes:
Includes guidance for flexible IRB review eligibility and types of research activities
Note:
Year
Subject:
IRB Member Performance Evaluation
Document Type:
Worksheet
Organization / Institution:
University of Miami
Target Audience:
IRB Chairs, IRB Managers
Period of Effectiveness:
Annual
Document type:
Institutional review form
Organization:
University of New England Institutional Review Board
Jurisdiction:
United States
Scope:
International human subjects research
Applicable research formats:
In-person research; Online-only research
Intended submitter:
Principal Investigator
Regulatory framework:
U.S. federal human subjects research regulations
Review body:
Institutional Review Board
Contact information:
[email protected]
Version date field:
Yes
IRB number field:
Yes
Target audience:
Faculty, staff, and student researchers
Geographic focus:
Research conducted outside the United States
Compliance topics:
Ethics approval, informed consent, data protection, export control regulations
Note:
Year
Document type:
Checklist
Target audience:
Investigators, IRB staff
Context description:
A checklist for investigators and IRB staff to assess and ensure regulatory compliance in clinical and non-clinical research studies.
Year:
2025
Region / City:
Louisiana
Topic:
Alcohol and Drug Survey
Document Type:
Guidelines
Organization / Institution:
Louisiana Board of Regents
Author:
Dr. Allison Smith
Target Audience:
IRB administrators, researchers, university staff
Period of Validity:
2025
Approval Date:
October 4, 2024
Amendment Date:
November 15, 2024
Year:
2023
Region / City:
Emory University
Topic:
IRB Determination for Research Involving Minors
Document Type:
IRB Determination Checklist
Organization:
Emory University
Author:
Emory Institutional Review Board (IRB)
Target Audience:
Researchers, IRB members, Clinical researchers, Academic institutions
Effective Period:
Ongoing
Approval Date:
2023
Date of Changes:
Not specified
Note:
Study Summary 1.1 Please provide a brief summary of the study in the table below. A complete description of the study with detailed information should be provided in the body of the protocol. For sections not applicable to the study, mark them as N/A. Study Title Study Design Primary Objective/Purpose Secondary Objective(s)/Purposes Research Intervention(s) ClinicalTrials.gov NCT # Study Population Sample Size Study Duration for individual subjects Study Specific Abbreviations/ Definitions
Background 3.1 Provide the scientific or scholarly background for, rationale for, and significance of the research based on the existing literature and how will it add to existing knowledge. :
this section should be limited to only information directly related to the research questions and objectives. Do not include your full dissertation proposal. 3.2 Describe any relevant preliminary data (e.g. pilot data).
Procedures Involved 5.1 Describe and explain the study design. 5.2 Please select the methods that will be employed in this study (select all that apply):
☐ Audio/Video Recording ☐ Psychophysiological Recording ☐ Behavioral Interventions ☐ Record Review - Educational ☐ Behavioral Observations and Experimentations ☐ Record Review - Employee ☐ Deception ☐ Record Review- Medical ☐ Focus Groups ☐ Record Review - Other ☐ Interviews ☐ Specimen Collection or Analysis ☐ Investigational Medical Device – (e.g. Medical Mobile Applications) ☐ Surveys and/or Questionnaires ☐Psychometric Testing ☐ Other Social-Behavioral Procedures Provide a description of all research procedures being performed and when they are performed. (Upload any surveys, questionnaires, interview scripts, focus group scripts, debriefing scripts, psychometric tests, stimulus materials, intervention manuals, and data collection forms on the Local Site Documents page in the IRB application.) 5.3 Describe the procedures or interventions that are going to be conducted as part of the research project, but that would have been conducted anyway, even if the research was not occurring (i.e. standard of care procedures, activities that would occur in a classroom). 5.4 Describe the procedures performed to lessen the probability or magnitude of risks of items selected in 5.2.5. 5 If accessing or collecting existing data, describe: The data that will be collected during the study (e.g. demographics, medical history, etc.). Attach the data capture sheet(s) on the Local Site Documents page in the IRB application. How the data will be obtained, including how you have the authority to access the data. The source or location of the data (e.g. USF Epic, TGH Epic, Hillsborough County School records, CANVAS records, publicly available databases, etc.). 5.6 If collecting and/or analyzing biological specimens, describe: How the biological specimens will be or have been collected. How the biological specimens will be stored. How long the biological specimens will be stored. How the biological specimens will be used. The laboratories that will be used. Whether the collected biological specimens will undergo genetic testing. If so, indicate if this study is part of a Genome Wide Association Study (GWAS) and whether the data will be forwarded to the NIH dbGaP. 5.7 If there are plans for long-term follow-up (once all research related procedures are complete), what data will be collected during this period.
Data and Specimen Storage for Future Research 6.1 If data or specimens will be banked for future research studies, describe where the data or specimens will be stored, how long it/they will b:
the process to request a release, approvals required for release, who can obtain data or specimens, and the data to be provided with specimens.
Note:
Year
Document Type:
Checklist
Author:
Dr. Twyla Williams-Damond
Context:
A checklist for ensuring all components are complete for an IRB application, including informed consent, recruitment templates, and readability reports.
Note:
Year
Document Type:
Checklist
Target Audience:
IRB members, researchers, committee staff
Context description:
A checklist for ensuring that IRB meeting minutes fulfill specific requirements related to protocol reviews and compliance with regulatory standards.
Year:
2023
Region / City:
Boston
Topic:
Quality Improvement, Research Ethics, Institutional Review Board
Document Type:
Guideline
Organization / Institution:
Boston Medical Center
Author:
Nicholas Cordella, MD
Target Audience:
Faculty, Staff
Period of Validity:
Ongoing
Approval Date:
Not specified
Modification Date:
Not specified