IRB Approved Clinical Research Studies 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 Approved Clinical Research Studies request form should only be used to obtain EMPAC numbers for the procurement of devices for your IRB Approved Clinical Research Study. If there is any question related to this, please contact Tynysha Moseley, firstname.lastname@example.org
- The IRB Approved Clinical Research Studies 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 Approved Clinical Research Studies portal is intended for UCLA Health only. Users must be connected to the UCLA network (intranet) to access this form.
IRB Request Form