• This consent form generator is designed to ask you a series of questions about your human subjects research plans. Based on your answers to these questions, a Microsoft Word document will be generated for you that should incorporate the majority of consent form language that is applicable to your protocol. The document can be edited in Microsoft Word, and additional edits may be needed as required for your specific protocol needs and/or as directed by the IRB before, during, and after the approval process.

    To begin, please read through these initial, standard instructions for consent forms. The consent generator is designed to include the below requirements; however, you must ensure these standards continue to be met:

    • All forms should be submitted to the IRB in PDF form suitable for reproduction (printing single sided or available electronically) using, at minimum, reasonable 12-point font and 1-inch margins.
    • Each page of the consent form should be full without inappropriate divisions: sections can be split (some on one page, some on another page) so that large blank areas do not exist, and the signature block is not on the page by itself.
    • All pages, including a 1-page consent form, must include page numbers (e.g., Page 1 of 1) and (if applicable) a blank for the participant's initials at the bottom of each page.
    • The informed consent form must be written in the second person (i.e., using the pronouns you, your, and yours). When combined with conditional language, utilization of the second person personalizes the consent form and reflects the existence of voluntary decision making on the part of the prospective subject.
    • The informational content of the elements of informed consent should not be mixed or repeated unless necessary. Information presented under any given element should be reasonably complete and restricted to content appropriate to that element. This helps the prospective subject focus on each individual element of consent thereby increasing the validity of the consent process.
    • The consent form must be written in simple enough language so that it is readily understood by the least educated of the subjects to be enrolled. Normally, the highest level of language in the consent form should equate to a seventh-grade standard. Scientific terms should be avoided when possible. If scientific terms are included, the lay term or definition should be provided.
    • Please remember, the age of majority in Nebraska is 19 years old. Anyone younger than 19 requires parental consent/assent or a waiver of parental consent must be approved by the IRB.
  • Please enter the contact information for the person filling out/editing this form. This person will receive a JotForm summary email and edit link.

  • 4. Do you have collaborators at other institutions who are also engaged in this project?*
  • 5. Will your protocol involve Social/Behavioral/Educational-focused work with normal, healthy adult participants aged 19 years (State of Nebraska) or older?
  • ?

    X

    Social/Behavioral More Info

    Social/Behavioral/Educational research is generally defined by topic areas, not methodology. This includes research involving human behavior and social functioning and the social and biological contexts of behavior including such disciplines as sociology, psychology, anthropology, human ecology, history, and communications. Education research is included in this category.

  • 6. Will your protocol involve Biomedical/Clinical research-focused work with normal, healthy adult participants aged 19 years (State of Nebraska) or older?
  • ?

    X

    Biomedical More Info

    This work is generally defined as research involving human biological function, pathology, or clinical issues, diagnosis, or treatment. Health research, including public health, health services research, and epidemiology should also be included in this category.

  • Will you be collecting biospecimens directly from participants, including but not limited to cells, tissues, saliva, blood, serum, human excreta, hair, teeth, etc.?
  • Will the biospecimens be used for commercial profit, or is there potential for their use for commercial profit?
  • Will the analysis of biospecimens include whole genomic sequencing?
  • Will clinically relevant research results and/or incidental findings be shared directly with participants?
  • Will participants be able to choose whether or not they want to receive these clinically relevant research results and/or incidental findings?
  • Does this study involve the creation, access, use, and/or collection of Private Health Information (PHI) regulated by the Health Insurance Portability and Accountability Act (HIPAA), including studies done by member(s) of the UNL Barkley Clinic workforce or multi-institutional collaborators?
  • Will any of this data be banked for other research projects in the future that would be approved under different IRB projects?
  • Will this project intentionally exclude females of childbearing potential or females who are pregnant or breast feeding for any reason?
  • Is this project:
  • A commercial study funded by a third-party sponsor?
  • A study funded by a federal research grant?
  • A study funded internally by department or faculty funds?
  • None of the above.
  • 7. Will your protocol involve normal, healthy UNL students? (Note: Restrictions apply to the use of this type of consent as specific to the corresponding IRB project.)
  • 8. Has this project been classified as greater than minimal risk?*
  • 9. Is your project funded by the NIH, or will your protocol include a Certificate of Confidentiality (CoC)?*
  • ?

    X

    NIH / CoC

    For more information about CoCs, please visit: https://research.unl.edu/researchcompliance/guidance-topics-a-z/ under “Certificates of Confidentiality”

  • 10. Does your protocol involve genetic research?*
  • ?

    X

    Genetic Research

    For more information about the Genetic Information Nondiscrimination Act (GINA), please visit: https://research.unl.edu/researchcompliance/guidance-topics-a-z/#GINA.

  • 11. Does your protocol involve compliance with the International Conference on Harmonization-Good Clinical Practice Compliance (ICH-GCP)?*
  • ?

    X

    ICH-GCP

    For more information about the ICH-GCP, please visit: https://research.unl.edu/researchcompliance/guidance-topics-a-z/#ICH-GCP.

  • Does your protocol include a randomization procedure to determine who is being assigned to which study group?*
  • in
  • 12. Will your protocol require registration with ClinicalTrials.gov?*
  • ?

    X

    ClinicalTrials.gov

    For more information about ClinicalTrials.gov, please visit: https://research.unl.edu/researchcompliance/guidance-topics-a-z/ under “Clinical Trials Registration, Consent Form Posting & Data Sharing.”)

  • 13. Will your protocol involve storing or processing Personal Information from participants who will be physically located in either the United Kingdom or the European Economic Area at the time of participation?*
  • ?

    X

    European Economic Area

    For more information about the European Union General Data Protection Regulation (EU GDPR), please visit: https://research.unl.edu/researchcompliance/guidance-topics-a-z/ under “European Union General Data Protection Regulation (EU GDPR).”

  • Are you collecting data anonymously, or will you obtain identifiers during the study?*
  • 16. Have you requested, or do you plan to request, a waiver of consent documentation (i.e., signature)?*
  • ?

    X

    Consent Waiver More Info

    Many online surveys do not require participants to sign a document or type their name in. If you intend to request a waiver of consent documentation, this will remove the signature lines and instead specify that consent is implied.

  • ?

    X

    Age Range More Info

    If there is no upper range on age of participation, the second number can be left blank.

  • 18. Other than age, are there any other criteria for inclusion?*
  • 19. Will your procedures include:

    Item                                   Number         Time                                          

  • Will the surveys be completed in-person on paper, or online?*
  • Will the interviews be completed in person, over the telephone, or online through a program such as Zoom?*
  • Will the interviews be audio and/or video recorded?*
  • Will the focus groups be completed in person or online through a program such as Zoom?*
  • Will the focus groups be audio and/or video recorded?*
  • ?

    X

    Other Activities Note

    If your project involves multiple intervention procedures such as blood draws, urine/stool samples, or other activities, these will need to be manually explained within Section 7 of the informed consent form.

  • 20. Does your project include:*
  • 21. Do you intend to share de-identified data outside of the research team (For example: as part of publication requirements? Or to share with other researchers?)*
  • ?

    X

    De-Identified Data More Info

    Many journals now require authors to share de-identified datasets for publication. This depends on the journal and the research discipline, but it is recommended that information regarding the potential for data sharing be included.

  • Will the data be coded or will the data be fully de-identified with no code?*
  • 22. Are there any risks in this study:*
  • 23. Are participants expected to get any direct benefits from participation in this study? (Compensation is NOT a direct benefit.)*
  • 25. Will you be compensating participants for their participation (e.g., cash, gift cards, extra credit)?*
  • Will participants receive $100.01 or more in a single payment?*
  • Do participants have to complete all research procedures in order to receive compensation?*
  • Will participants only be compensated one time?*
  • Please specify the type of compensation:*
  • Will the gift cards be provided via Virtual Incentives?*
  • Please specify the type of gift card:*
  • ?

    X

    VI More Info

    For more information about Virtual Incentives, please visit https://research.unl.edu/research-participant-compensation-process/

  • Will the gift cards be physical or digital?*
  • Please specify where the gift card is to:*
  • Please explain how much extra credit will be provided:*
  • ?

    X

    Course Points More Info

    Specify whether participants will receive a specific number of points or if they will receive a specific % of their grade in extra credit.

  • ?

    X

    Timeline More Info

    For example: You will receive $25 cash for completing the survey and a $25 gift card for completing the interview, for a total of $50.

  • Do any of the above-mentioned payments include gift cards sent via Virtual Incentives?*
  • Should be Empty: