IACUC Amendment Form

OMB Control Number: 1024-0XXX

Expiration Date:

U.S. National Park Service

Institutional Animal Care and Use Committee

Amendment Form

TO:

FROM:

DATE:

The items listed below are considered major/significant protocol changes by the NPS IACUC (the Committee), and thus require submission of this amendment form to the Committee for review and approval of said changes. Other proposed changes may also be considered significant in addition to those listed below. Such changes will be assessed on a case-by-case basis. Should you have any questions as to whether or not your proposed protocol change requires an amendment, please consult the NPS IACUC. Amendments must receive approval prior to their inclusion/assimilation into existing, approved protocols.

• Changing the objectives of the study

• Changing from non-survival to survival surgery

• Changing the degree of invasiveness of a procedure or discomfort to an animal

• Performing a new procedure or changing a procedure being used

• Changing the species or the approximate number of animals used

• Changing personnel involved in animal procedures

• Changing anesthetic agent(s), the use or withholding of analgesics

• Changing methods of euthanasia

• Changing the duration, frequency, or number of procedures performed on an animal

IACUC Protocol Number:

Principal Investigator:

Title of Project/Course:

1. Please describe in all possible detail your proposed amendment(s). If more than one change is proposed, list each change.

2. Please substantiate any/all proposed changes to your project.

CERTIFICATION OF THE PRINCIPAL INVESTIGATOR: Signature certifies that the Principal Investigator understands the requirements of the NPS IACUC Policy and applicable IRAC principles governing the use of vertebrate animals for research, testing, teaching and/or exhibition purposes. Signature certifies that the investigator will continue to conduct the project in full compliance with the aforementioned requirements. Signature further certifies that the proposed work does not unnecessarily duplicate previous work.

Signature:

Date:

APPROVAL NOTIFICATION (for continuing projects): The above amendment was approved by the NPS Institutional Animal Care and Use Committee (IACUC) as submitted. This form and any modifications will be kept on file in the office of the IACUC Coordinator.

NPS IACUC Chair (or DMR Lead Reviewer)

Date:

Paperwork Reduction Act Statement: The National Park Service is authorized by the Animal Welfare Act Regulations (7 U.S.C. 2131-2159;§2.31, d, 1) to collect this information for the purposes of reviewing activities related to the care and use of animals and to approve all research, teaching, and exhibition activities involving vertebrate animals on NPS managed lands and territories. Your response to this request is mandatory in order to conduct research involving vertebrate animals on NPS managed lands and territories. The time to complete this form is estimated to be15 minutes per response. A Federal agency may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a currently valid OMB Control Number. You may send comments concerning the burden estimates or any aspect of this information collection to: John A. Bryan, II, DVM,

NPS IACUC Chair and Attending Veterinarian, National Park Service,1201 Oakridge Drive, Suite 200, Fort Collins, CO 80525.

3