ŠĻą”±į>ž’ bdž’’’a’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’ģ„Į!` łæbjbj\­\­ ?:>Ē>ĒŖi’’’’’’¤X X X X X X X ’ $¦0¦0¦08Ž0D"1D¶ęOŽr1r2ˆ2ˆ2ˆ2c3y4” 5LeOgOgOgOgOgOgO$ÄQh,T ‹OX @7c3c3@7@7‹OX X ˆ2ˆ2Ū OX8X8X8@7X ˆ2X ˆ2eOX8@7eOX8X8āiJ¤X X YLˆ2f1 šr MK Ę¦0P7( K9N,¶O0ęO#K6ĢTx7ŠĢT,YLĢTX YLąY5hĮ5JX8 6<G6łY5Y5Y5‹O‹OH8Y5Y5Y5ęO@7@7@7@7¶„ :¤Ž¤ ‚'$ ¶:Ž‚'l € Ž X X X X X X ’’’’ BLUE MOUNTIAN COMMUNITY COLLEGE INSTITUTIONAL REVIEW BOARD EXEMPT CHECKLIST  EXEMPTION SCREENING QUESTIONS Research activities in which the only involvement of human subjects will be in one or more of the categories under 45CFR46.101(b) qualify as exempt. Even if your study may qualify as exempt, you must complete and submit this application to the office of the IRB. The determination of exemption may only be made by the IRB designee, not the researcher. Exempt studies do not require continued IRB monitoring. However, any changes made to exempt research must be submitted to and approved by the IRB. If you answer ‘yes’ to any of the questions below, your study will not qualify as exempt research and you must complete the full IRB application. Please answer all of the questions on this page. If the question does not apply, mark ‘No.’ For research involving special populations, interventions or manipulations:YNDoes your research involve  HYPERLINK "http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm" \l "46.303" prisoners? Does your study involve deception of subjects? Does your research involve survey or interview procedures with children as subjects? Does your research involve observation of children in settings where investigator(s) will participate in the activities being observed? FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX  For research using survey procedures, interview procedures, or observational procedures (NOTE: exemption is not allowed in surveys or interviews with children as subjects):YNIf the data are to be recorded by audiotape or videotape, and were the information to be revealed or disclosed, could this place subjects at risk (risks may be psychological, social, physical, economic, or legal)? Are subjects identifiable (e.g. by name or through demographic data) and will collection of information include sensitive data (e.g., illegal activities or sensitive issues such as sexual orientation, sexual behavior, undesirable work behavior or other embarrassing information)? If subjects are identifiable either by name or through demographic data, are there potential risks to subjects if the information is revealed or disclosed? FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX  For research using existing or archived data,** documents, records, or specimens:YN** “Existing” means collected (i.e., on the shelf) prior to the research for a purpose other than the proposed research. It includes data or specimens collected in research and nonresearch activities. Will any data, documents, records, or specimens be collected from subjects after permission is granted by the IRB to commence the research? If the existing data, documents, records, or specimens are originally labeled with identifiers and are not publicly available, is the investigator recording the data in such a manner that subjects can be identified, directly or indirectly through identifying links (e.g., demographic information that might reasonably lead to the identification of individual subjects – name, phone number, medical record number, audio or video tape, social security number, or any code number that can be used to link the investigator’s data to the source record)?  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX  For instructions and guidance on completing the forms for the IRB process refer to the Researcher’s IRB Information Packet on the website:  HYPERLINK "http://www.bluecc.edu/home/IRB" www.bluecc.edu/home/IRB     PAGE 1 Exempt Checklist: 06/06 Courtesy of Saint Louis University LMYZ[^}ž¢õūF G Į Ź R [ v x » ¾ < ńßϽ«§ “ƒ“y“ƒ“o“y“b“T“Gh<åhī•OJQJ^Jh<åh/>*OJQJ^Jh<åh½1DOJQJ^Jh­1¹OJQJ^JhoūOJQJ^Jh<åh/6OJQJ]^Jh<åh/OJQJ^J h<åh/hE")"h<åh­1¹5CJOJQJ\aJ"hoūh­1¹5CJOJQJ\aJ$h<åh­1¹>*CJ$OJQJaJ$"h<åh­1¹5CJOJQJ\aJ$h­1¹5CJOJQJ\aJ$ <Z[\]^|}w x < = h i µ · ¹ ööö¶““““²­­­­„­öŸŸ$If$a$gdī•$a$?kd$$If–P4”¹Ö°’€Š’’’’’’’’’’’’’’’’öŠööÖ’’’’Ö’’’’Ö’’’’Ö’’’’4Ö Paöf4ytE") $$Ifa$Ŗżż< = Q U b c f g h i “ ¹ Õ Ö * + , 5 6 E óŪĆŪ«Ū«Ūˆzo`UC`6`ohE")h/0JCJaJ#jähE")h/CJUaJhE")héĖCJaJjhE")héĖCJUaJhE")h/CJaJhE")h/5CJ\aJ(hE")h/56CJOJQJ\]aJh<åh/6OJQJ]/hE")hin>6B*CJOJQJ\^JaJph’/hE")h &b6B*CJOJQJ\^JaJph’/hE")h/6B*CJOJQJ\^JaJph’h<åh2¶OJQJ^J¹ ŗ 9 h ½ E W i {  Ÿ ± Ć Õ  –––Œ††††††††$If  & F$If & F$If_kdp$$If–l4”2ÖF”’ž%j'6) &iiö6Ö ’’’Ö ’’’Ö ’’’Ö ’’’4Ö laöf4 E F T U V W X f g h i j x y z { | Š ‹ Œ  Ž œ  ž Ÿ   ® Æ ° ± ² Ą Į Ā Ć Ä Ņ šåÓšåšåĮšåšåÆšåšåšåšå‹šåšåyšåšågšåšå#j•hE")h/CJUaJ#j!hE")h/CJUaJ#j­hE")h/CJUaJ#j9hE")h/CJUaJ#jÅhE")h/CJUaJ#jQhE")h/CJUaJ#jŻhE")h/CJUaJhE")h/CJaJjhE")h/CJUaJ%Ņ Ó Ō × „…‰Š}()*ķŽÓ¼„¼”€Óo`M>(M+j_hE")h/CJOJQJUaJhE")h/CJOJQJaJ%jhE")h/CJOJQJUaJhE")h/CJOJQJaJ hE")h/CJOJQJ^JaJ&hE")h/5CJOJQJ\^JaJ hE")h/CJOJQJ^JaJ,hE")h &b56CJOJQJ\]^JaJ,hE")h/56CJOJQJ\]^JaJhE")h/CJaJjhE")h/CJUaJ#j hE")h/CJUaJÕ Ö × …‡‰£žŠyy ĘL,dš$*$1$If$ ĘL,dš$*$1$Ifa$$a$\kd}$$If–l”ćÖF”’ž%j'6) &iiö6Ö ’’’Ö ’’’Ö ’’’Ö ’’’4Ö laö‰Š`}+,>?@Rdew£…ttttttttt ĘL,dš$*$1$If  & F$If & F ĘL,dš$*$1$If\kdė$$If–l”RÖF”’ž%j'6) &€i€iö6Ö ’’’Ö ’’’Ö ’’’Ö ’’’4Ö laö *,-;<=@AOPQRSabceftuvyzˆ‰Š‹©¼ńŽńČŽńŽń²ŽńŽńœŽńŽń†ŽńŽńpŽńeT hE")h/56CJ\]aJhE")h/CJaJ+j­hE")h/CJOJQJUaJ+j7hE")h/CJOJQJUaJ+jĮhE")h/CJOJQJUaJ+jKhE")h/CJOJQJUaJ+jÕhE")h/CJOJQJUaJ%jhE")h/CJOJQJUaJhE")h/CJOJQJaJwxy‹Œ©ūż’īī~~~ $$Ifa$ $„Š„0ż^„Š`„0ża$Zkd# $$If–lÖF”’ž%j'6) &iiö6Ö ’’’Ö ’’’Ö ’’’Ö ’’’4Ö laö ĘL,dš$*$1$If¼Öėģū’ ōõū'(ƒ†‡•–—™šØ©Ŗ­®¼ķÜĖܽܲ§²œ²‘²œ²Ü|Üd|Ü|ÜL|Ü|Ü/jq hE")h/56CJU\]aJ/jū hE")h/56CJU\]aJ)jhE")h/56CJU\]aJhE")hm,`CJaJhE")h &bCJaJhE")h+ tCJaJhE")h/CJaJhE")h/5CJ\aJ hE")h &b56CJ\]aJ hE")h/56CJ\]aJ#hE")h/56>*CJ\]aJ’›Ó_„…†˜™«¬­æĄŅ£““ & F$If$If\kd $$If–l”zÖF”’ž%j'6) &hhö6Ö ’’’Ö ’’’Ö ’’’Ö ’’’4Ö laö¼½¾ĄĮĻŠŃÓŌ`aŽ¦§Ø©Ŗ«­®°±³“ø¹ŗēŅĮŅĮ©ŅĮ¢š•‹•{‹q‹•f¢^Z^Z^Z^ZTZ h/@ˆCJh/@ˆjh/@ˆUh<åh/CJaJh-!hoū0J5j= h-!hoū5Ujhoū5U hoū5h<åh/5 h<åh//j] hE")h/56CJU\]aJ hE")h/56CJ\]aJ)jhE")h/56CJU\]aJ/jē hE")h/56CJU\]aJŅÓŌ©Ŗ¬­Æ°²³µ¶„‰zjhhhhhhhh$„Š„0ż^„Š`„0ża$gdE") ĘL,dš*$1$gdoū$ ĘL,„¦’dš&d *$1$PĘ’ ^„¦’a$ZkdÓ $$If–lÖF”’ž%j'6) &hhö6Ö ’’’Ö ’’’Ö ’’’Ö ’’’4Ö laö ¶¹ŗÅŽżūļźźääūūŌ$„Š„0ż^„Š`„0ża$gdE")„h]„hgdČÖ „ų’„&`#$gdĪK“ ŗ»ĮĀĆÄÅõļõäõÜŌɼ±«§  h<åh/h/@ˆ h/@ˆCJhŠC~h/@ˆCJ aJ h§2ųh/@ˆ0JCJ aJ h§2ųh/@ˆCJ aJ h/@ˆCJ aJ h/@ˆ0JCJh/@ˆ0JmHnHu h/@ˆ0Jjh/@ˆ0JU = 0&PP/R :pKBP°Š/ °ą=!°Š"°&#@$ %°°Š°Š Šn$$If–!vh5ÖŠ#vŠ:V –P4”¹öŠö5ÖŠ/Ö ’’’’’’’’4Ö4Ö Pf4ytE")r$$If–!vh5Ö &5ÖĢ5ÖĢ#v &#vĢ:V –l4”2ö6ö5Ö &5Öi4Öf4łDŠÉźyłŗĪŒ‚ŖK©  ąÉźyłŗĪŒ‚ŖK© vhttp://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm46.303tD’’’’eCheck2tD’’’’eCheck3tD’’’’eCheck4tD’’’’eCheck5tD’’’’eCheck6tD’’’’eCheck7tD’’’’eCheck8tD’’’’eCheck9l$$If–!vh5Ö &5ÖĢ5ÖĢ#v &#vĢ:V –l”ćö6ö5Ö &5Öi4Ör$$If–!vh5Ö &5ÖĢ5ÖĢ#v &#vĢ:V –l”Rö6ö,Ö5Ö &5Öi4ÖvD’’’’eCheck10vD’’’’eCheck12vD’’’’eCheck13vD’’’’eCheck11vD’’’’eCheck14vD’’’’eCheck15h$$If–!vh5Ö &5ÖĢ5ÖĢ#v &#vĢ:V –lö6ö5Ö &5Öi4Öl$$If–!vh5Ö &5ÖĢ5ÖĢ#v &#vĢ:V –l”zö6ö5Ö &5Öh4ÖvD’’’’eCheck16vD’’’’eCheck19vD’’’’eCheck17vD’’’’eCheck18h$$If–!vh5Ö &5ÖĢ5ÖĢ#v &#vĢ:V –lö6ö5Ö &5Öh4ÖćDŠÉźyłŗĪŒ‚ŖK© www.bluecc.edu/home/IRBąÉźyłŗĪŒ‚ŖK© >http://www.bluecc.edu/home/IRB†"œN@ń’N Normal7$8$ CJOJQJ_HaJmH sH tH X@X Heading 1$$„Ąō@&]„Ąōa$5CJOJQJ\aJv@v Heading 2+$$ Ęp@ x<f!*$1$@&a$5@ˆž’CJOJQJ\^JaJp@p Heading 3%$ Ę<$`'0**$1$@&5@ˆž’CJOJQJ\^JaJX@X Heading 4$$„Z@&]„Za$5CJOJQJ\aJZ@Z Heading 5$$@&a$ 56CJOJQJ\]^JaJT@T Heading 6$$@&a$5CJOJQJ\^JaJR@R Heading 7$@&5>*CJOJQJ\^JaJR@R Heading 8$@&5>*CJOJQJ\^JaJh @h Heading 9! $ Ęh„h*$1$@&]„h5CJOJQJ\^JaJDA@ņ’”D Default Paragraph FontVi@ó’³V  Table Normal :V ö4Ö4Ö laö (kō’Į(No List 8+ņ8  Endnote Text1$RB@R Body Text$*$1$a$@ˆž’CJOJQJ^JaJ4@4 Header  ĘąĄ!4 @"4 Footer  ĘąĄ!6U@¢16 Hyperlink >*B*ph’JC@BJ Body Text Indent5CJ\aJdR@Rd Body Text Indent 2„h„˜ž^„h`„˜žCJOJQJ^JaJ*W@¢a* Strong5\dS@rd Body Text Indent 3„Š„0ż^„Š`„0żCJOJQJ^JaJ^Q@‚^ Body Text 3 ĘL,dL’*$1$CJOJQJ^JaJ>@’>  Footnote TextCJaJ@&¢”@ Footnote ReferenceH*TT@²T Block Text„Š„Š]„Š^„ŠCJOJQJ^JaJHP@ĀH Body Text 26OJQJ]^JaJB"@B Caption$a$5OJQJ\^JRYāR  Document Map-D MĘ ’€ OJQJ^J.)@¢ń. 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