University of Chicago IRB Reliance Agreement

FORM: IRB Reliance Agreement
Document No.:

Edition No.:

HRP-235

001.2

Effective Date:

21 Jun 2022

Page:

Page 1 of 3

Complete this form when a local IRB has jurisdiction over this research site.
You must submit a typed version of this form (except for the signature block) to prevent errors and delays due to
legibility problems.
Blank & incomplete answers will result in delayed reviews
If you have questions about the use of this form, please contact WCG IRB at 855-818-2289 or email clientcare@wcgirb.com
Relying Organization:
Name:
FWA #:

University of Chicago BSD-IRB
00005565 (if organization has an FWA)

Contact Information for Relying Organization:
Name:
Title:

Jeremy LaVigne, MA, CIP
IRB Reliance Manager

Address 1:

University of Chicago

Address 2:

5841 South Maryland

City:
Zip/Postal Code:
Phone:

State/Province:

Chicago

Country:

60637

Email:

(773) 834-8262

IL
USA
jlavigne@bsd.uchicago.edu

This agreement covers all human subjects research conducted by this site (otherwise complete the “Research Protocol” and “Principal
Investigator” sections below)
Research Protocol:
Protocol #:
Protocol Title:

None
Understanding HIV/STD Risk and Enhancing PrEP Implementation Messaging in a Diverse
Community-Based Sample of Gay, Bisexual, and Other Men Who Have Sex with Men in a
Transformational Era (MIC-DROP)

Sponsor Name:

Centers for Disease Control and Prevention

IRB Tracking #:

20225896 (if known)

Principal Investigator:
Name:

John Schneider, MD

The Relying Organization agrees to waive jurisdiction for the IRB review and continuing oversight of the Research Protocol to WCG
IRB (IRB registration number IRB00000533) (“Designated IRB”) as allowed under federal regulations. The Principal Investigator is
authorized to conduct the Research Protocol at the Relying Organization.
The review performed by the Designated IRB will meet the human subject protection program requirements of applicable regulatory
agencies. The Designated IRB will follow its written procedures for the review and oversight of the Research Protocol. The Designated
IRB will follow its written procedures for reporting findings and actions, subject complaints, unanticipated problems involving risks to
subjects or others, serious or continuing noncompliance, and suspension or termination to appropriate institutional officials at the
Relying Organization. Relevant minutes of IRB meetings will be made available to the Relying Organization upon request. Relying
Organization remains responsible for ensuring compliance with the Designated IRB’s determinations and with the terms of any

Copyright © 2016 WIRB-Copernicus Group, Inc. All rights reserved.

FORM: IRB Reliance Agreement
Document No.:

HRP-235

Edition No.:

001.2

Effective Date:

21 Jun 2022

Page:

Page 2 of 3

agreements between the Relying Organization and applicable regulatory agencies. This document must be kept on file by both parties
and provided to applicable regulatory agencies upon request.

Copyright © 2016 WIRB-Copernicus Group, Inc. All rights reserved.

FORM: IRB Reliance Agreement
Document No.:

HRP-235

Edition No.:

Effective Date:

001.2

21 Jun 2022

For Designated IRB

For Relying Organization

Signature

Signature

Printed Name

Jennifer A Ponting
Printed Name

Director, Expedited Review

Title

Page 3 of 3

Associate Vice President for Research, Director of University
Research Administration
Title

18-Aug-2023 | 11:01:01 AM EDT

Date

Page:

8/10/23
Date

Copyright © 2016 WIRB-Copernicus Group, Inc. All rights reserved.