SUNY Downstate Yes No Yes No Yes No NYC +HH, KC Other: SUNY Downstate Yes No Yes No Yes No NYC +HH, KC Other: SUNY Downstate Yes No Yes No Yes No NYC +HH, KC Other: SUNY Downstate Yes No Yes No Yes No NYC +HH, KC Other: a. b. c. d. e. f. Name & degree Role(s) on Project. of employment Will this person be Is this person an Will this person aid Examples: Principal REMINDER: is also obtaining verbal or for the “Investigator the shipment of Investigator, required for all NYC H+H written Informed purposes of COI hazardous materials Coordinator, research. Consent/Authorization reporting”? (e.g., dangerous Consultant, Fellow, goods, specimens) to Resident, Student, be transported by a FEDERALLY Research Staff, Healthcare public carrier? FUNDED STUDIES Operations only, Access to ONLY de-identified data only, Specimen shipment, etc. SUNY Downstate Yes No Yes No Yes No NYC +HH, KC Other: SUNY Downstate Yes No Yes No Yes No NYC +HH, KC SUNY Downstate Yes No Yes No Yes No NYC +HH, KC Other: SUNY Downstate Yes No Yes No Yes No NYC +HH, KC Other:
SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No a. Name & degree b. Role(s) on Project. Examples: Principal Investigator, Coordinator, Consultant, Fellow, Resident, Student, Research Staff, Healthcare Operations only, Access to de-identified data only, Specimen shipment, etc. c. of employment REMINDER: is also required for all NYC H+H research. d. Will this person be obtaining verbal or written Informed Consent/Authorization e. Is this person an “Investigator for the purposes of COI reporting”? FEDERALLY FUNDED STUDIES ONLY f. Will this person aid the shipment of hazardous materials (e.g., dangerous goods, specimens) to be transported by a public carrier? SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No SUNY Downstate NYC +HH, KC Other: Yes No Yes No Yes No
ApplicationforExemptReview2018.03.14.docx