IRB CERTIFICATION OF TRANSLATION FORM



IRB CERTIFICATION OF TRANSLATION FORM

For Translation of Documents into a Language other than English

(Submit Translated Documents with this Form)

IRB Protocol No.:     

FOR ORIGINAL TRANSLATION

Title of Research Project:     

Name of Principal Investigator:     

Language Translated Into:      

Title of Each Document Translated:      

Name of Person Who Completed Original Translation:     

Street Address:     

City, State, Zip Code:     

I hereby certify that I am the person who did the attached original translation; I will not be involved in doing the “back translation” of the document(s). The attached translation is accurate to the best of my abilities.

Signature of Original Translator: Date:     

Printed Name:     

FOR “BACK TRANSLATION” INTO ENGLISH

Title of Research Project:     

Name of Principal Investigator:     

Title of Each Document Back Translated into English:      

Name of Person Who Completed "Back Translation”:     

Street Address:     

City, State, Zip Code:     

I hereby certify that I am the person who did the attached "back translation" into English; I was not involved in the original translation of the document. The attached "back translation" is accurate to the best of my abilities. Though I may have received compensation for performing the "back translation," I am not affiliated with the above-titled research project, which I understand would constitute a "Conflict of Interest."

Signature of “Back Translator” Date:     

Printed Name:     

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