Templates/Forms

Templates or Forms should be used when there is a standard set of materials or information that needs to be conveyed to your research participant(s) and, if applicable, those who are authorized to provide consent on their behalf.  Templates provided by the UNL Human Research Protection Program (HRPP) can be useful tools when developing your IRB application materials.  Templates with information applicable to consent, recruitment, confidentiality, etc. are available.

Note: Our templates have been updated to reflect 2018 new regulatory requirements per the changes to the Common Rule (45 CFR 46). The templates will look different and convey information in a slightly different manner than previous templates. For the most part, the information is still very similar to what was provided previously. However, these changes have been made in order to help us meet the new requirements, promote a consent process through conversation with the participant and also be in alignment with peer institutions as we anticipate further collaboration.  

Assent Template

Assent Form– to be used when a minor or decisionally-impaired adult participates in research, does not provide consent on their own accord, or a waiver of parental/legal guardian consent was approved by the IRB.

Consent Templates

Social-Behavioral Adult Participant Informed Consent– to be used with normal-healthy adult participants age 19 years (State of Nebraska) or older.

Biomedical Adult Participant Informed Consent to be used with normal-healthy adult participants age 19 years (State of Nebraska) or older.

UNL Student Informed Consent– to be used with normal healthy UNL students – restrictions apply to the use of this form specific to the corresponding project.

Parent-Legal Guardian Informed Consent with Parent Notification Form– to be used when the target population does not have the legal authority to consent for themselves including minors or decisionally-impaired adults.

The end of the document also includes a Parent Notification Form. This is to be used in combination with the informed consent in educational settings when the project has been approved by the site including the use of notification only AND the project is not subject to the Protection of Pupil Rights Amendment.

Certificate of Confidentiality Template Languageto be used when a project has been issued a Certificate of Confidentiality by the National Institutes of Health or any other Federal agency. A certificate can be issued either as part of the projects award terms or through a separate CoC application process. To learn more about CoCs please visit the Guidance page.

Web, Email and/or Cover Letter Based Informed Consent- to be used when consent will be sent to participants via email or letter and not completed in-person or via written signature.

Short Forms

Participants who have limited English proficiency may be enrolled in your research provided that you have the resources to communicate effectively during the recruitment process, while obtaining consent, and for the duration of the study. The short form consent is typically used when the potential participant does not speak English and there is not enough time to translate the English version of the approved consent document into a language the potential participant understands.

Use of the short form process and forms below MUST be approved prior to implementation through submission of the Short Form Request Form. Please review HRPP policy #9.008 titled Use of the Short Form Consent Document to learn about the process of approval.

Short Form Request Document

French Short Form

Russian Short Form

Croatian Short Form

Spanish Short Form

Vietnamese Short Form

Hmong Short Form

Arabic Short Form

Somalian Short Form

Private Health Information (PHI) Authorization Template

PHI Authorization Form to be used when the research project will require the research participant to provide permission to access private or protected health information from a covered entity AND you do not readily have access to the covered entity’s own PHI Authorization form.  Minimal information is required to be added since most of the language found in this form should not be revised. The template provides language that meets the standard requirements regulated by the Health Insurance Portability and Accountability Act.

Advertisements / Fliers

While researchers are NOT required to use the templates for advertisements or fliers, the UNL IRB offers the following examples for use:

Recruitment, Verbal Scripts, Follow-Up and Reminder Templates

These templates are to be used when contacting participants for recruitment, reminders or follow-up notifications whether via phone, email or letter.

Report New Information, Unanticipated Problems, Non-compliance, Serious Adverse Events, etc.

The Incident Report Form is no longer available. Instead, we have implemented a new and improved reporting system via the Reportable New Information Form (RNIF) in NUgrant. For situations that arise in an active and approved project that must be reported to the IRB, please login to your specific project in NUgrant and click on “add a new form;” the RNIF is available as a form to be selected for completion.  Incidents that require reporting must be reported within 48 hours of awareness. A detailed listing of what is required for reporting on the RNIF is also described in NUgrant where you select the form. If you have questions about the RNIF or a situation that may need to be reported, please do not hesitate to call or email your IRB Coordinator.

Translation Certification

Translation Certification Guidance and Form – to be used when any documents related to an IRB approval or determination must be translated from either English to a particular language or vice versa.