Washington State Department of Social and Health Services

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Research Application

Appendix A: Additional Research Staff

Appendix B: Research Involving Pregnant Women, Human Fetuses, and Neonates as Subjects

Appendix C: Research Involving Prisoners as Subjects

Appendix D: Research Involving Children as Subjects

Appendix E: Unaffiliated Investigator Agreement

Appendix F: Recruitment, Consent/Assent, and Authorization Documents

• Consent Form Template
• HIPAA Authorization Template

Appendix G: Requests for Use or Disclosure of Records |Contact List (October 2011)|

Appendix H: Resource Requests

Appendix I: Waiver of Consent/Authorization

Appendix J: Electronic Data Security Plan

 | Data Security Exhibit |

Appendix K: Data Collection Instruments

Appendix L: Miscellaneous Study Documents

Appendix M: Application for Funds Awarded to DSHS, DOH, and/or L&I

We only accept applications submitted on our current forms.

Our application documents were updated as of 12/1/11. We will accept earlier versions of the application until 3/1/12.