Institutional Review Board (IRB) Authorization Agreement

Name of Institution or Organization Providing IRB Review:

Lawrence Berkeley National Laboratory or Berkeley Lab

IRB Registration #: 00006447 Federalwide Assurance (FWA) #: 00006253

Name of Institution Relying on the Designated IRB (Institution B):	FWA #:

The Officials signing below agree that (Name of Institution B) may rely on the designated IRB for review and continuing oversight of its human subjects research described below: (check one)

☐ This agreement is limited to the following specific protocol(s):

Name of Research Protocol:

Name of Principal Investigator:

Sponsor or Funding Agency: U.S. Department of Energy Award Number, if any:

☐ Other (describe):

The review performed by the Berkeley Lab IRB, the Human Subjects Committee, will meet the human subject protection requirements of Institution B’s Office of Human Research Protections (OHRP)-approved FWA. The IRB at Berkeley Lab will follow written procedures for reporting its findings and actions to appropriate officials at Institution B. Relevant minutes of IRB meetings will be made available to Institution B upon request. Institution B remains responsible for ensuring compliance with the Terms of its OHRP-approved FWA and the determinations of the Berkeley Lab IRB, including but not limited to:

IRB directives to terminate designated research activities;

Educational training required by the Institution and/or the IRB prior to initiating research covered under this Agreement;

Ensuring that the staff of Institution B follow the protocol(s) as approved by the IRB.

This document must be kept on file by both parties and provided to OHRP upon request.

Signatory Official, Institution A: ______________________________________ Date ___________

Name: Carol J. Burns, PhD Institutional Title: Berkeley Lab Deputy Director for Research

Address:	Lawrence Berkeley National Laboratory	Phone #: 510-486-6100

1 Cyclotron Road, MS50A4119

Berkeley, CA 94720

Signature of Signatory Official (Institution B):

_________________________________________________________Date: ______________

Print Full Name: Institutional Title: