RESEARCH & RELATED Other Project Information
1.
* Are Human Subjects Involved?
Y: Yes
Yes
N: No
No
1.a. If YES to Human Subjects
Is the Project Exempt from Federal regulations?
Y: Yes
Yes
N: No
No
If YES, check appropriate exemption number:
✔
1
✔
2
✔
3
✔
4
✔
5
✔
6
If NO, is the IRB review Pending?
Y: Yes
Yes
N: No
No
IRB Approval Date:
Human Subject Assurance Number
2.
* Are Vertebrate Animals Used?
Y: Yes
Yes
N: No
No
2.a. If YES to Vertebrate Animals
Is the IACUC review Pending?
Y: Yes
Yes
N: No
No
IACUC Approval Date:
Animal Welfare Assurance Number
3.
* Is proprietary/privileged information included in the application?
Y: Yes
Yes
N: No
No
4.a.
* Does this project have an actual or potential impact on the environment?
Y: Yes
Yes
N: No
No
4.b. If yes, please explain:
4.c. If this project has an actual or potential impact on the environment, has an exemption been authorized or an environmental assessment (EA) or
environmental impact statement (EIS) been performed?
Y: Yes
Yes
N: No
No
4.d. If yes, please explain:
5.
* Is the research performance site designated, or eligible to be designated, as a historic place?
Y: Yes
Yes
N: No
No
4.b. If yes, please explain:
6.
* Does this project involve activities outside the United States or partnership with international collaborators?
Y: Yes
Yes
N: No
No
6.a. If yes, identify countries:
6.b. Optional Explanation:
7.
* Project Summary/Abstract
8.
* Project Narrative
9.
Bibliography & References Cited
10.
Facilities & Other Resources
11.
Equipment
12.
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