When a participant is a child, under the age of 18, documentation of consent must be obtained from the parent(s). Additionally, assent may be required for children ages 7-17. Please review the following Investigator Guidance Series documents that provide in depth information about the parental permission and assent processes:

• Research Involving Children
• Parental Permission
• Assent 
• Wards of State

When a participant is cognitively or decisionally impaired, he/she may not be able to understand the study information and consent process presented. In these cases, documentation of consent must be obtained a legally authorized representative of the participant. Additionally, assent may be required for adults who are cognitively/decisionally impaired but can understand the study well enough to provide assent.  Please review the following Investigator Guidance Series documents that provide in depth information about the LAR consent and participant assent processes:

• Research Involving Individuals with Decisional Impairment
• Assent

When a participant does not speak English, consent documentation must include proof that the consent process and elements were provided in the participant's language. This means that consent documents must be translated into the language understood by the participant.  

A translator with appropriate language expertise must translate the consent documents. The translator certifies his/her translation by writing a letter to describe his/her qualifications for the translation.  A template Translation Certification Letter can be found on the IRB Forms pages.

There are situations when a translation of the consent document cannot be obtained. In these cases, the IRB may consider it appropriate to use a translated short form in combination with an oral interpretation of the full English consent document. A short form is like a cover letter to the full consent form, telling the participant what to expect during the oral consent process discussion of the study. When using the short form process to obtain and document consent, strict rules must be followed according to the federal regulations, described in the Short Form Instructions for Use.  Pre-translated short forms are available on the IRB Forms pages.

In most cases, and in all cases when using the short form, a qualified interpreter must assist in the consent process. Members of the study team who are fluent in a participant's language may also provide interpretation. Investigators must be sure that the individuals providing interpretation and translation services have appropriate medical/scientific language skills to accurately communicate the details of the study.  

Consent without a signature can only be approved by an IRB in the following situations:

• The only record linking the subject and the research would be the consent document and the principal risk would be potential harm resulting from a breach of confidentiality.
• In this scenario, each participant must be asked whether he/she would like to sign a consent document. If the participant declines to sign, but voices consent verbally, he/she can still be in the study.  
• The research presents no more than Minimal Risk of harm to subjects and involves no procedures for which written consent is normally required outside of the research context.

• Participants in this study are members of a distinct cultural group or community in which signing forms is not the norm. The research presents no more than Minimal Risk of harm to subjects and the study team has an alternative mechanism for documenting that informed consent was obtained.

Consent without a signature requires that a waiver of documentation of consent be requested in the IRB application. The IRB application asks for justification according to the situations above.  

In many cases, it is still appropriate to provide the participant with written information about the study, discussing the required consent elements.  This is often done using a consent cover letter; a model consent cover letter can be found further down on this page.

When a signature is not obtained, another method must be used to document consent in the research record. Consider the consent process example scenarios below for additional methods of consent documentation.  

An opt-in model is one where the participant must affirm his/her consent before the study team may begin procedures. A participant may opt in by signing a consent form, verbally consenting, or using another acceptable method. 

An opt-out model is one where the participant does not have to affirm consent before his/her inclusion in the study begins, but must affirm dissent if he/she wishes to be excluded from the study.  Opt-out models are often used when the participant does not have to physically engage in any study procedures; for example, when existing data about the participant will be analyzed for the research.