Att 6g_Amity Medical Group IRB agreement






		


Institutional Review Board (IRB) Authorization Agreement
Name of Institution or Organization Providing IRB Review (Institution/Organization A):
Florida State University (FSU)
IRB Registration #: IRB00000446 Federalwide Assurance (FWA) #, if any: FWA00000168
Name of Institution Relying on the Designated IRB (Institution B): Amity Medical Group
IRB Registration #: IRB00000971Federalwide Assurance (FWA) # FWA00029542
The Officials signing below agree that may rely on the designated IRB for review and continuing
oversight of its human subjects research described below: (check one)
(___) This agreement applies to all human subjects research covered by Institution B’s FWA.
(_xx_) This agreement is limited to the following specific protocol(s):
Name of Research Project: Expanding PrEP in Communities of Color (EPICC+) (
EPICC+Training & Cohort) STUDY00003652
Name of Principal Investigator: Dr. Lisa Hightow-Weidman
Site Investigator: Joel Wesley Thompson, MHS,PA-C, AAHIVS,DFAAPA
Sponsor or Funding Agency:
Award Number, if any:
(___) Other (describe):________________________________________________________________
The review performed by the designated IRB will meet the human subject protection requirements of
Institution B’s OHRP-approved FWA. The IRB at Institution/Organization A 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 IRB’s determinations and with the Terms of its OHRP-approved FWA. This
document must be kept on file by both parties and provided to OHRP upon request.
Signature of Signatory Official (Institution/Organization A):



	



________________________________________ Date: ___________

Print Full Name: T. Howard Stone, JD, LLM, CIP Institutional Title: Director Office for Human Subjects
Protection
Signature of Signatory Official (Institution B):
3/8/2023
________________________________________ Date: ___________
Executive Director
Print Full Name: _____________ Institutional Title: ______________________