INSTRUCTIONS: Request for Determination of Exempt Status

• Note: No human research activity may proceed until this request has been reviewed and determined exempt by the CPHS.

• Read information in Exemption Categories (Part I) carefully before selection.

• If you are claiming exemption under Category #4, Existing Data, complete Part II. Note that the data or specimens must exist prior to the inception of the proposed activity/analysis.

• If you are claiming exemption under any category other than #4, prepare and attach two copies of the protocol and consent form as indicated in Part III.