Forms

Thank you for using the OHRP website resources. The structure and content of this site will change after IRB submissions move to WRAP in February, to reflect the updated system and review process. A preview of the updated website is available for everyone to review and explore in preparation for the change. We anticipate minor disruptions and delays during the transition and will greatly appreciate your patience through this process.

Quick Access

Most Used Forms	Pre-Approval	Informed Consent	HIPAA
Electronic Informed Consent	Reliance	Approved Studies	Study Management
Special Approvals	General OHRP Forms	Concerns/Complaints

Most Used Forms

	WVU Research Data Protection and Determination Form (WVU Build Form)
	WVCTSI Case Study Authorization Form (WVCTSI iLab Form)
	WVCTSI Case Study Authorization Form (DOCX)
WVU OHRP-23	Adult Non-Medical Consent Template	v8.0 6/2024
WVU OHRP-24	Adult Medical Consent Template	v10.0 7/2025
WVU OHRP-25	Informational Cover Letter - Exempt, Flex, NHSR	v4.0 5/2025

Pre-Approval

	WVU Research Data Protection and Determination Form (WVU Build Form)
	PDF Instructions: Modify a Submitted WVU Build Form (Data Protection Requests and HIPAA Waivers)

Informed Consent

Informed Consent Templates

More Than Minimal Risk and Only Minimal Risk

WVU OHRP-23	Adult Non-Medical Consent Template	v8.0 6/2024
WVU OHRP-24	Adult Medical Consent Template	v10.0 7/2025

Cover Letter Templates

Only Minimal Risk

WVU OHRP-27	Expedited Cover Letter Template **only use when requesting a waiver of documentation	v6.0 5/2025
WVU OHRP-25	Exempt, Flex, NHSR Cover Letter Template	v4.0 5/2025

Assent Templates

More Than Minimal Risk and Only Minimal Risk

WVU OHRP-35	Child Assent Form Template	v1.0 6/2022
WVU OHRP-36	Parent-Guardian Consent Form Template	v10.0 7/2025

Only Minimal Risk

WVU OHRP-37

Combined Parent-Guardian and Child Consent Form Template

v8.0 6/2024

P lease note: WVU Informed Consent Templates are required when WVU IRB is the IRB record. Exceptions will be considered on a case-by-case basis.

HIPAA

WVU OHRP-21	HIPAA Waiver of Authorization Request Form (WVU Build Form)
WVU OHRP-38	Standalone HIPAA Authorization Form (DOCX)
	WVCTSI HIPAA Preparatory to Research Request Form (Link to Instructions)
	WVCTSI HIPAA Preparatory to Research Request Form (Link to WVUCTSI iLab)
WVU OHRP-22	HIPAA Decedent Authorization (WVU Build Form)
	PDF Instructions: Modify a Submitted WVU Build Form (Data Protection Requests and HIPAA Waivers

Electronic Informed Consent

Submission Worksheets

WVU OHRP-45

eIC Submission Worksheet (DOCX)

Not required for NHSR, Exempt, or Flex protocols without PHI.

REDCap eTemplates

The files listed below must be accessed in the REDCap library and cannot be downloaded.

WVU OHRP-e01 with e07	Remote eConsent with ID Verification Questions
WVU OHRP-e02	In-Person eConsent
WVU OHRP-e03	Cover Letter/Informational Sheet
WVU OHRP-e04	Separate HIPAA Authorization
WVU OHRP-e05	Standalone Assent
WVU OHRP-e08	Recruitment Send eIC for Review Only
WVU OHRP-e09	cIRB Combo Reliance Informed Consent Form with Signature, Email

Qualtrics eTemplates

• Download and upload the IRB-approved eTemplates into Qualtrics
• The files are in Qualtrics format (.QSF) and cannot be opened unless they are uploaded into Qualtrics.
• Qualtrics cannot be used for MMR protocols (Full Board Protocols)

Combo Forms 

WVU OHRP-e01	OMR eConsent (QSF File) **HSC Qualtrics Required for PHI
WVU OHRP-e04	Standalone HIPAA eAuthorization (QSF File)

Other eTemplates

WVU OHRP-e06	Survey eTemplate (QSF File)
WVU OHRP-e08	Recruitment/Send Information for Review (QSF File)

Reliance

WVU OHRP-43	Reliance Request Form (WVU Build Form)
Advarra Consent Language	WVU-Required Consent Language for Advarra IRB (DOCX)
WCG IRB (WIRB) Consent Language	WVU-Required Consent Language for WCG IRB (WIRB) (DOCX)

Approved Studies

WVU OHRP-08	Research Event Form - PI and Research Staff (WVU Build Form)
WVU OHRP-33	Protocol Closure Form (WVU Build Form)
WVU OHRP-05	Protocol Status (WVU Build Form)

Study Management Resources

WVU OHRP-40	Lost to Follow-up Notification Template (DOCX)
WVU OHRP-41	Participant Follow-up Notification Template (DOCX)
WVU OHRP-06	Change in PI Letter Template (DOCX)
WVU OHRP-10	Data Safety Monitoring Plan Template (DOCX)
WVU OHRP-11	SAE/AE Tracking Log Template (DOCX)
WVU OHRP-12	Deviation Tracking Log Template (DOCX)
WVU OHRP-30	Training Log Template (DOCX)
WVU OHRP-31	Delegation of Authority Log Template (DOCX)

Special Approvals

WVU OHRP-19	Letter of Permission for External Site (DOCX)
	WVCTSI Case Study Authorization Form (WVCTSI iLab Form)
	WVCTSI Case Study Authorization Form (DOCX)
	WVU Research Participant Payment Method Approval Form (WVU Build Form)
WVU OHRP-15	Participant Photo/Media Authorization (DOCX)
	NIH Certificate of Confidentiality (NIH Online Form)
	WVCTSI HSC New Onsite Data Repository Approval Form (WVU Build Form)
	WVCTSI HSC New Onsite Biospecimen Repository Approval Form (WVU Build Form)
WVU RO-05	CITI Program Administrator Confidentiality Agreement (WVU Build Form)

General OHRP Forms

WVU OHRP-01	IRB Meeting Confidentiality Agreement (WVU Build Form)
WVU OHRP-04	WVU HRPP Information Access Request (WVU Build Form)
WVU OHRP-34	COI Letter to External Party Letter (DOCX)

Concerns/Complaints

WVU OHRP-07	Participant/Researcher Complaint or Concern Form (WVU Build Form)
	WVU Ethics Line (Ethics Point Online Form)

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