Materials Transfer Form
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Start Date Use of human subjects / patients No Yes If yes, IRB approval number date Use of vertebrate animals No Yes Use of recombinant DNA Use or Derivation of Human Pluripotent Stem Cells No Yes If yes, IACUC approval number date If yes, specify Exempt, Biosafety Level I, II, III, or human gene transfer No Yes If yes, date of HPSCRO Committee approval Classified research No Yes If yes, contact DRDA Project Representative Restrictions on openness of research No Yes If yes, contact DRDA Project Representative Telephone End Date Do the Principal Investigator, Participating Investigators, or other key investigators have “significant financial interest or management interest” in the proposed project that may constitute the basis for a conflict of interest See Instructions for Policy Statement.. No No No No No Yes Yes Yes Yes Yes Are requested materials dangerous to handle, store or use No Yes If yes, date of committee approval If yes, date of RPC approval If yes, specify If yes, specify If yes, identify location of research If yes, how If yes, DRDA will notify UM Risk Management Office NOTES: Written agreements from the provider to allow transfer of materials must be signed by someone specifically authorized by the Regents to sign agreements and contracts on behalf of the University..
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