IRB and Clinical Study Trial Request Disclaimer

Please read before proceeding to fill out the form

By clicking on the IRB request form button below, you acknowledge and consent to the following important disclaimers:

• The IRB Request Form should only be used to obtain EMPAC numbers for the procurement of devices for your IRB and Clinical Study Trials.  If there is any question related to this, please contact Tynysha Moseley, tmmoseley@mednet.ucla.edu

• The IRB request form has no save feature. Please make sure to have all necessary information and documentation (e.g. FDA HDE letter, IRB approval notice, supporting documents, etc.) prior to starting your submission form.

• Requestors MUST reattach all files to the form during the second attempt if an error occurred during original submission. The request will not go through and an error message will appear.

• The IRB and Clinical Study Trial Request portal is intended for UCLA Health only. Users must be connected to the UCLA network (intranet) to access this form.

IRB Request Form