Listed below are the Kaiser Permanente Southern California Institutional Review Board Applications, Forms, and Reports.  These documents are available by contact the Kaiser Permanente Southern California Institutional Review Board.  

 New Research - IRB Applications

�     KPSC Full Research Application

�     Interregional  Research Application

�     KPSC Exempt Request Form

�    Humanitarian Use Device (HUD) Application

�     KPSC Exempt Request Form

�    HMORN Research Application Cover Sheet

 New Research -  IRB Forms

Ø     Principal Investigator Attestation and Risk Assessment (RAMP)

Ø     KPSC Conflict of Interest Policy Statement

Ø     KPSC Policies and Regulations Agreement

�     HIPAA Questionnaire Application

�     Research Use Of Internet Questionnaire

�     Federal Project Budget Template

�     Internal Project Budget Template

�     Industry Project Budget Template

�     Biographical Sketch Template

 Research Reporting Forms

�     Modification Request Form

�     Protocol Deviations, Violations, and Exemptions Summary

�     Continuing Review Form

�     KPSC Humanitarian Use Device (HUD) Progress Report and Continuing Review Form

�     IRB Authorization Agreement - KPSC Ceding

�     IRB Authorization Agreement -KPSC Reviewing to Research

�     Unaffiliated Investigator Agreement

�     Single Patient Use IND Application

 Principal Investigator Reportable Events and Incidents

Ø     Internal Unanticipated Serious Adverse Event Report

Ø     External Unanticipated Serious Adverse Event Repor

Ø     Unanticipated Adverse Device Effect Report

Ø     Emergent Modification 5 Day Report and Request

Ø     Unanticipated Problem Report

 Other Forms

Ø     45 CFR 46.118 Destination

Ø     Intention to Use PHI Prepatory to Research (RAPTOR)

Ø     Human Subjects Research Assessment

Ø     Determination of KPSC's Engagement in Research

�     Local Context Form