Repository Submission Tracking [TEMPLATE - WITH EXAMPLES] ***Please see the "IRB Help - Repositories: Tracking Submissions and Releases" for additional information about this template.*** Date of Source of Data/Specimens Description of Data/Specimens Study Status Individually Consent and Authorization Methods Submittal Agreement Submission Identifiable? Signed [EXAMPLE 1] Tom Jones Laboratory (OHSU) - Blood and Tumor Tissue from 5678 Yes - coded, Consent to storage and future 5/14/2010 5/16/2010 IRB #s 5678, 1234, 5432 prior subjects in breast cancer Terminated repository has research on CANCER ONLY. studies 1234 - access to Authorization to store in identifiers repository. 5432 - Active [EXAMPLE 2] University of Washington [Title] Blood samples from relatives of Closed to No Consent/authorization silent on 6/1/2010 6/2/2010 breast cancer patients Enrollment storage/future research. Not identifiable, no waiver needed. [Example 3] OHSU Clinical Records Data on treatment of bacterial N/A - clinical Yes - repository OHSU IRB approved waiver of N/A - data collected 7/7/2010 infections in immunocompromised records will code consent/auth on 7/1/2010. by repository breast cancer patients investigators Repository Release Tracking [TEMPLATE - WITH EXAMPLES] ***Please see the "IRB Help Sheet - Repositories: Tracking Submissions and Releases" for additional information about this template.*** Date of Release PI Name Institution Title of Research Project IRB Approval Status Description of Data/Specimens Individually Sharing Genetic Name Released Identifiable? Agreement Opt-Out Signed Verified [EXAMPLE 1] Jane OHSU Breast Cancer Genetic Study 8/14/2010 - 2 mL aliquots of blood from all No 8/15/2010 Yes 8/21/2010 Smith subjects breast cancer patients determination (eIRB # 9999) [EXAMPLE 2] John University Qualitative Tumor Tissue N/A - 100 tumor tissue slides No 9/2/2010 N/A 9/3/2010 Doe of Chicago Analysis Study
Repository Submission Tracking [TEMPLATE - WITH EXAMPLES] ***Please see the "IRB Help - Repositories: Tracking Submissions and Releases" for additional information about this template.*** Date of Submission Source of Data/Specimens Description of Data/Specimens Study Status Individually Identifiable? Consent and Authorization Methods Submittal Agreement Signed [EXAMPLE 1] 5/16/2010 Tom Jones Laboratory (OHSU) - IRB #s 5678, 1234, 5432 Blood and Tumor Tissue from prior subjects in breast cancer studies 5678 1234 - Terminated 5432 - Active Yes - coded, repository has access to identifiers Consent to storage and future research on CANCER ONLY. Authorization to store in repository. 5/14/2010 [EXAMPLE 2] 6/2/2010 University of Washington [Title] Blood samples from relatives of breast cancer patients Closed to Enrollment No Consent/authorization silent on storage/future research. Not identifiable, no waiver needed. 6/1/2010 [Example 3] 7/7/2010 OHSU Clinical Records Data on treatment of bacterial infections in immunocompromised breast cancer patients N/A - clinical records Yes - repository will code OHSU IRB approved waiver of consent/auth on 7/1/2010. N/A - data collected by repository investigators Repository Release Tracking [TEMPLATE - WITH EXAMPLES] ***Please see the "IRB Help Sheet - Repositories: Tracking Submissions and Releases" for additional information about this template.*** Date of Release PI Name Institution Name Title of Research Project IRB Approval Status Description of Data/Specimens Released Individually Identifiable? Sharing Agreement Signed Genetic Opt-Out Verified [EXAMPLE 1] 8/21/2010 Jane Smith OHSU Breast Cancer Genetic Study 8/14/2010 - subjects determination (eIRB # 9999) 2 mL aliquots of blood from all breast cancer patients No 8/15/2010 Yes [EXAMPLE 2] 9/3/2010 John Doe University of Chicago Qualitative Tumor Tissue Analysis Study N/A - 100 tumor tissue slides No 9/2/2010 N/A
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