Request for Amendment to an Approved IRB Protocol Principal Investigator (Current): CITI Member ID Number: Email: Approved Protocol Number: Approved Project Title: Select the proposed change(s) to the project (Select all that apply): Extension of project dates Project title Data source Assessments ( i.e. PI change* Personnel (other than PI)* survey/interview questions, Research location Subject compensation activities or interventions) Advertisements/Flyers Other Describe in detail the requested changes. If requesting more than one change, numerically list the changes (Use as much space as necessary). *If adding research personnel, please include the name, email and CITI Member ID Number for each individual listed: Select all documents that require revision or any documents submitted as a result of the requested change: IRB Application Survey/Interview Questions Permission Letter(s) Recruitment material (flyers, scripts or letters) Consent Form(s) Other (Explain): Will the requested changes affect the risks or benefits of the project? No Yes (Explain):
Request for Amendment to an Approved IRB Protocol Principal Investigator (Current): CITI Member ID Number: Email: Approved Protocol Number: Approved Project Title: Select the proposed change(s) to the project (Select all that apply): Extension of project dates Assessments ( i.e. survey/interview questions, activities or interventions) Project title PI change* Research location Advertisements/Flyers Data source Personnel (other than PI)* Subject compensation Other Describe in detail the requested changes. If requesting more than one change, numerically list the changes (Use as much space as necessary). *If adding research personnel, please include the name, email and CITI Member ID Number for each individual listed: Select all documents that require revision or any documents submitted as a result of the requested change: IRB Application Permission Letter(s) Consent Form(s) Survey/Interview Questions Recruitment material (flyers, scripts or letters) Other (Explain): Will the requested changes affect the risks or benefits of the project? No Yes (Explain):