This form must be completed on an annual basis by the principal investigator for all active
projects that have been previously exempted from IRB review.
I. Project Identification
Title of Project
Principal Investigator (PI)
VA Central IRB Project #
PI Contact Information Phone: E-mail: Assigned VAMC:
Date of Original
Date of Project
II. Status of Project
The Principal Investigator must check one of the following boxes regarding the status of the
project and attach any pertinent documentation.
The project remains active. There have been no changes in the project from what was
previously reviewed by the VA Central IRB. The project remains exempt from IRB review.
There have been changes in the project that have not been previously reviewed by the IRB.
Attached is a copy of the changes for IRB review. I believe that the project remains exempt
from IRB review.
The study is closed or has been withdrawn or terminated. Attached is a VA Central IRB Form
117, Project Closure Report.
III. Investigator Certification
The principal investigator must check each box and sign and date the form.
I understand that any future changes in the project must be reported to the VA Central IRB
for review to determine if the project remains in an exempt status.
Even though this project is exempt from IRB review, I understand that I still have ultimate
responsibility for the ethical conduct of the research and for safeguarding the rights and
welfare of all the human participants involved.
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VA CIRB Form 118