The code block below illustrates how one might use # and // as comments in your logic and calculations.

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The value you provided must be within the suggested range

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This value is admissible, but you may wish to double check it.

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Required format:

z3DLts4fvRGWnYQEmLSHQTTfrM54pWMB2B87ihE9iZIPgBM8W5

Medical School IRB Protocol Review Extension Program

This program is designed to support investigators in the completion of timely IRB protocols. Investigators are encouraged to complete this form soon after the IRB has granted a PI-initiated 30-day extension to respond to IRB queries.

The following information will be critical if additional time beyond this 30-day extension will be needed to respond to IRB queries for your protocol submission. Requests for an additional extension will be reviewed by the Medical School Research Office, and feedback will be provided as needed.

Requests will be reviewed by the Medical School Research Office within 10 business days, and feedback will be provided as needed. Requests received on a Friday after 12:00PM CMT will be reviewed the following business week. The Research Office cannot guarantee that requests submitted with a shortened window (< 10 business days) for review will be finalized before the IRB Expiration Date.

Study Title:

* must provide value

PI Last Name:

* must provide value

PI email:

* must provide value

PI Direct Phone Number:

Ethos Number:

* must provide value

OnCore Number:

Date a response is due to the IRB:

* must provide value

M-D-Y

What was the last action taken by the IRB?

* must provide value

Date of last action taken by the PI:

* must provide value

M-D-Y

Is the source of delay related to an ancillary review?

* must provide value

Yes

reset

Which ancillary review group(s)?

* must provide value

Who have you been communicating with from the ancillary review group(s)?

* must provide value

Please describe the reason for the delay.
What work has been done-to-date towards finding a resolution? What is within the control of the PI to complete?

* must provide value

Expand

What is the expected date of resolution?

* must provide value

M-D-Y

Is the source of delay related to an external sponsor?

* must provide value

Yes

reset

Please describe the reason for the delay.
What work has been done-to-date towards finding a resolution? What is within the control of the PI to complete?

* must provide value

Expand

What is the expected date of resolution?

* must provide value

M-D-Y

Is the source of delay related to an IRB question or concern?

* must provide value

Yes

reset

Who have you been communicating with from the IRB?

* must provide value

Please describe the reason for the delay.
What work has been done-to-date towards finding a resolution? What is within the control of the PI to complete?

* must provide value

Expand

What is the expected date of resolution?

* must provide value

M-D-Y

Is the source of delay related to a study team or a department level question or concern?

* must provide value

Yes

reset

Please describe the reason for the delay.
What work has been done-to-date towards finding a resolution? What is within the control of the PI to complete?

* must provide value

Expand

What is the expected date of resolution?

* must provide value

M-D-Y

Is the source of delay related to any other University governing body not identified above?

* must provide value

Yes

reset

Please describe the reason for the delay.
What work has been done-to-date towards finding a resolution? What is within the control of the PI to complete?

* must provide value

Expand

* must provide value

M-D-Y

Is there any other information you believe important to share for our review of this request?

Expand

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