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Ption number. If no, is the IRB review Pending? 1 Yes No 2 3 4 5 6 No IRB Approval Date: Human Subject Assurance Number: 2. * Are Vertebrate Animals Used? 2.a. Yes No If YES to Vertebrate Animals Is the IACUC review Pending? Yes No IACUC Approval Date: Animal Welfare Assurance Number 3. * Is proprietary/privileged information included in the application? Yes 4.a. * Does this project have an actual or potential impact on the environment? No Yes No 4.b. If yes, please explain:.

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