14.01 Appendix BNIST Administrative Manual, Subchapter 14.01
Transmittal Date - 11/17/98 



APPENDIX B
INFORMATION NEEDED FOR RESEARCH PROPOSAL TO THE NIST INSTITUTIONAL REVIEW BOARD

Date of submission:

Through: Group Leader [Need signature]

Division Chief [Need signature]

From: Principal Investigators and Other Investigators: [Name, degree, whether PI 
or other (post-doc, guest researcher, NIST employee or contractor, etc.), NIST 
address, telephone number, email address, FAX]

1. Title of Project:

2. Site:

3. Estimated Duration of Study (including Experimental Schedule)

4. Number of Subjects:

5. Types of Subjects (include Selection Criteria for Subjects and method of 
recruitment of subjects; vulnerable subjects include people with mental or 
cognitive impairment, handicapped, economically disadvantaged, and other) NOTE: 
Research involving protected classes of subjects under 45 CFR Part 46 Subpart B, 
C, or D, i.e., pregnant women, fetuses and human in vitro fertilization, 
prisoners, and children, may not be reviewed by the NIST IRB. Such research must 
be reviewed by an outside IRB that possesses current assurances, appropriate for 
the research in question, from OPRR.

6. Purpose of Project:

7. Source of Funding:

8. Background and Objectives:

9. Experimental Protocol and Analysis Methods: (References for prior research in 
field can be added)

10. Summary of Human Subject Protocol

11. Potential Risks and Benefits:

12. Protection of Subjects against Potential Risks and Protection of the 
Subjects' Privacy:

13. Informed Consent Form:

14. THE FOLLOWING CERTIFICATION MUST BE INCLUDED: "I hereby certify that the 
information furnished concerning the procedures to be taken for the protection 
of human subjects is correct. I will seek and obtain prior Institutional Review 
Board (IRB) approval for any substantive modification of this protocol and will 
report any unexpected or otherwise significant adverse effects encountered in 
the course of this study."
_________________________________________________ [Signature of Principal 
Investigator(s) and date] 


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 National Institute of Standards and Technology,
Director of Administration - Management and Organization Division
gwenda.roberson@nist.gov
11/23/98