Barriers To Accepting Health Information Technology

All researchers must complete the Research Project Notification and Human Subjects Protection Form and receive all appropriate signatures before initiating any research. Please fill in each blank and provide copies of any additional documents (i.e. draft questionnaires) as necessary.
As outlined in UMUC Policy 130.25, Conducting Research Involving Human Subjects, all UMUC
students, staff, faculty, and individuals external to UMUC, who wish to conduct research involving
human subjects must adhere to this policy before conducting any research.
All researchers must complete the Research Project Notification and Human Subjects Protection Form
and receive all appropriate signatures before initiating any research. Please fill in each blank and provide
copies of any additional documents (i.e. draft questionnaires) as necessary.
If you have any questions about the form, ask your IRB representative.
Research Project Notification and Human Subjects Protection Form

1. Title of Project:
2. Purpose of the Project:
3. Survey Instruments or Data Collection Methodology to be used.
A. Interview, focus group, questionnaire, or other?
If other, please explain.
B. Online, regular mail, face-to-face, or other?
If other, please explain.
C. Please attach a copy of each instrument if it has been prepared. If not, explain how it will be
developed.
4. Research Design including population and sample, if applicable.
A. UMUC Students, Staff, Faculty, or other?
If other, please explain.
B. Sample Size
C. What information will be collected (e.g. any potentially sensitive subjects such as drug use,
etc)?
D. What data other than the respondents’ answers will be sought (e.g. via access to UMUC
records)?
E. How will the privacy and confidentiality of the human subjects be recorded and stored?
F. How will the analysis protect the respondent’s right to privacy (e.g., if less than five people
are in a table cell, how will their identity remain anonymous)?