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Human Subject Research Assessment
Complete this form to assist the GSPHHP HRPP Office in determining whether or not your project constitutes Human Subjects Research (HSR) and thus requires further HRPP/IRB review.
Last Name:
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First Name:
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EMPL ID:
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E-mail:
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Are you completing this form as:
If you're a student, are you submitting this for a fieldwork/capstone project or dissertation?
If you're a student, please select your concentration.
If you're submitting this for your fieldwork project, list your course instructor; if you're an MPH or MS student submitting for any other reason, list your faculty advisor; if you're a DPH student, list your dissertation chair.
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Project Title:
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Provide a brief, concise description of the proposed project, its purpose, and whether or how it qualifies as research. Research means a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge (45 CFR 46.102(d)).
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Describe any interaction or intervention with human subjects. Interaction includes communication or interpersonal contact between investigator and subject (45 CFR 46.102(f)) Intervention includes both physical procedures by which data are gathered (for example, venipuncture) and manipulations of the subject or the subject’s environment that are performed for research purposes (45 CFR 46.102(f)) Human subject means a living individual about whom an investigator (whether professional or student) conducting research obtains (1) Data through intervention or interaction with the individual, or (2) Identifiable private information (45 CFR 46.102(f)).
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Describe any identifiable private information about human subjects that you will obtain for research purposes. Private information includes information about behavior that occurs in a context in which an individual can reasonably expect that no observation or recording is taking place, and information which has been provided for specific purposes by an individual and which the individual can reasonably expect will not be made public (for example, a medical record) (45 CFR 46.102(f)).
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Briefly describe the investigator’s role in this research.
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If you're a Masters student, will you be working on a project for which there is an active CUNY IRB protocol? If yes, please provide the protocol number.
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Will this research be reviewed by an external (non-CUNY) IRB? If yes, please identify the institution, and if the external IRB review has been completed, please upload the determination letter at the following link: https://www.dropbox.com/request/hNPBLrRET9qOAKJUT7CN
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