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Forms & Templates 

Where are the Consent Document Templates?

Instead of consent templates, the University of Utah IRB offers detailed guidance and models to help you design your consent process. 

Learn more about this change

Do I Still Need the IRB Approval Stamp Footer?

If you submit your consent documents to the IRB as a Word Document, the watermark footer field is still required. You can also submit a PDF with a blank footer.

submitting consent documents to the IRB

Documents are in Word [DOC] format unless otherwise noted.

VA Documents and Forms
FORMS Tracked Changes Version Date

VA Authorization for Use & Release of Health Information Form 10-0493

(Note: Some users have reported difficulties viewing this document via an internet browser.  Try downloading it/saving it to your desktop if you cannot view it online.)

N/A Sept 2015
VA Emergency Use Consent Document Template   08.17.2015
VA Humanitarian Use Device (HUD) Consent and Authorization Document Template Tracked Changes 08.17.2015
VA IRB Documentation of Waiver of HIPAA Authorization for Research [PDF]   07.2011
VA Revocation of Authorization for Use & Release of Health Information Form 10-10116 N/A Sept 2015
Recruitment Materials
FORMS Tracked Changes Version Date
Recruitment Letter Template   05.14.2010
Simple Referral Template   05.14.2010
Full Protocol Documents
FORMS Tracked Changes Version Date
See: Preparation Packet for Investigator-Initiated Drug and Device Studies    
External Sites and Agreements
FORMS Tracked Changes Version Date
Data Use Agreement (DUA) Template - UUHSC - Please contact Technology Licensing Office   N/A
Data Use Agreement (DUA) Template - IHC   06.09.2008
Material Transfer Agreement (MTA) Template- Please contact Technology Licensing Office   N/A
Other Documents
FORMS Tracked Changes Version Date
Agreement for Public Ethnographic Studies   N/A
Certification for Emergency Use of a Test Article without Informed Consent   01.03.2012

Case Report Using Existing Data Author Worksheet [PDF]

Tracked Version 09.01.2015
Data / Biospecimen Repository Management Plan Template   02.18.2022
Department of Defense (DoD) Supplement [PDF Form]    04.18.2024
Exclusion of Research Data in EMR Request Form - Available on Pulse (University employee access only)
University of Utah Health Form Only; This is not a requirement of all studies that use the University of Utah IRB.  
  N/A
Exemption Umbrella Annual Report Template   09.01.2013
Payment Process Exception Request   01.08.2024
Privacy Protection Verification for Research Conducted in Schools   08.15.2017
Research Preparation Form   07.21.2014
Research Using Decedents' Information Form Tracked Version 10.23.2013
Last Updated: 6/12/24