Section 1 - Basic Information |
Required |
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1.1 Study Title |
Required |
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1.2 Exempt? |
NO |
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1.3 Exemption Number |
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1.4 Clinical Trial Questionaire |
All questions YES |
➡ 1.4.a "Does the study involve human participants?" defaults to Yes and is not editable |
1.5 ClinicalTrials.gov Identifier |
Optional |
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Section 2 - Study Population Characteristics |
Required |
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2.1 Conditions of Focus of Study |
Required |
➡ Up to 20 conditions, limited to 255 characters each |
2.2 Eligibility Criteria |
Required |
➡ Use dash+space for bulleted list |
2.3 Age Limits |
Required |
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2.3.a. Inclusion of Individuals Across the Lifespan |
Required |
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2.4 Inclusion of Women and Minorities |
Required |
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2.5 Recruitment and Retention Plan |
Required |
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2.6 Recruitment Status |
Required |
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2.7 Study Timeline |
Required |
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2.8 Enrollment of First Participant |
Required unless Inclusion Enrollment Report is using an existing dataset |
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2.9 Inclusion Enrollment Report(s) |
Required |
➡ Up to 20 reports can be added per study record |
1. Inclusion Enrollment Report Title |
Required |
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2. Existing Dataset or Resource? |
Required |
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3. Enrollment Location Type |
Required |
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4. Enrollment Country(ies) |
Optional |
➡ Autopopulates to USA for domestic; multi-select from list |
5. Enrollment Location(s) |
Optional |
➡ Type of location, not name |
6. Comments |
Optional |
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Planned Table |
Required if NOT using an existing dataset or resource |
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Cumulative (Actual) Table |
Required if using an existing dataset or resource |
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Section 3 - Protection and Monitoring Plans |
Required |
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3.1 Protection of Human Subjects |
Required |
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3.2 Multi-site study? |
Required |
➡ If YES, contact IRB office to develop sIRB Plan (irb@ora.msu.edu) |
Single IRB plan attachment |
Not required if NIH |
➡ If AHRQ and 3.2 is YES, attach IRB Plan (for NIH, plan will be reqired at JIT stage) |
3.3 Data and Safety Monitoring Plan |
Optional |
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3.4 Data and Safety Monitoring Board? |
Optional |
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3.5 Overall Structure of Team |
Optional |
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Section 4 - Protocol Synopsis |
Required |
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4.1a Detail Description |
Required |
➡ Up to 32,000 characters |
4.1.b Primary Purpose |
Required |
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4.1.c Interventions |
Required |
➡ Up to 20 interventions allowed |
4.1.d Study Phase |
Required |
➡ Select Y/N NIH Phase III |
4.1.e Intervention Model |
Required |
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4.1.f Masking |
Required |
➡ aka Blinding; if Yes, select types(s) |
4.1.g Allocation |
Required |
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4.2 Outcome Measures |
Required |
➡ At least 1, up to 50 allowed |
4.3 Statistical Design and Power |
Required |
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4.4 Subject Participation Duration |
Required |
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4.5 FDA-regulated intervention? |
Required |
➡ If yes, 4.5a explanation required |
4.6 Applicable clinical trial under FDAAA? |
Required |
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4.7 Dissemination Plan |
Required |
➡ Same can be used for multiple studies; filename must be unique for each study record |
Section 5 - Other Clinical Trial-related Attachments |
Only include per FOA |
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⬇
Finished.
Attach to PHS Human Subjects and Clinical Trials Information form. |
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