Institutional Review Board (IRB)
Division of Research
Office of Animal Welfare and Research Integrity
Room 130 Dyson Building
Tallahassee, Florida 32307-3800
irb@famu.edu
FORM G
SCREENING QUESTIONS CONTAINING IDENTIFIABLE INFORMATION
Form Instructions:
o This Form must be completed and submitted if the response to Question IV.H. in the IRB Application indicates
research involving collecting identifiers during screening.
o To complete the form, press TAB or SHIFT TAB between boxes and enter an ‘X’ or text. For assistance, contact
the Office for Animal Welfare and Research Integrity 850-412-5246
o Handwritten applications will NOT be accepted.
Project Title: _________________________________________________________________
____________________________________________________________________________
___________________________________________________________________________
Principal Investigator: _____________________________________________________________
Phone: ______________________________________________________________________
Email Address: _________________________________________________________________
1. How will the information obtained during screening be handled for individuals who qualify for the study? Choose
all that apply.
Store until the end of study & then destroy
Request permission from participant to maintain the information and to contact for future studies
Information will be handled in some other way Explain: ______________________________
____________________________________________________________________________
____________________________________________________________________________
___________________________________________________________________________
2. How will the information obtained during screening be handled for individuals who DO NOT qualify for the study?
Choose all that apply.
Immediately destroy the information Finished with Form G
Store until the end of study & then destroy Finished with Form G
Use as “screening failure” data for investigator(s) listed on this application Finished with Form G
Use as “screening failure” data & could be provided to others outside of the investigators listed on this
application Answer Questions 3 – 4
Request permission from participant to maintain the information and to contact for future studies finished
with
Form G
Information will be handled in some other way Explain:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
_____________________ Finished with Form G
3. Who outside of the investigators listed on this application will receive the data, in what form and why?