# Amendment Intake Form

Use this public-safe intake before drafting an IRB amendment packet.

## 1. Study

- Study title:
- PI:
- Current IRB protocol number:
- Current approval status:
- Amendment lead:
- Date:

## 2. Plain-language change

What is changing?

Why is the change needed now?

Who is affected by the change?

## 3. Study surfaces affected

- [ ] Recruitment
- [ ] Consent
- [ ] Survey/instrument
- [ ] Interview/focus group
- [ ] Learning platform
- [ ] AI tool or AI feedback
- [ ] Artifact upload or portfolio evidence
- [ ] Telemetry / interaction logs
- [ ] Data storage / access / retention
- [ ] Incentives
- [ ] Participants or eligibility
- [ ] Analysis plan

## 4. New or revised data elements

List each new data element, where it is collected, whether it is identifiable, and whether it is optional.

| Data element | Source | Identifiable? | Optional? | Stored where? | Who has access? |
|---|---|---:|---:|---|---|
| | | | | | |

## 5. Attachments needed

- [ ] Revised protocol language
- [ ] Revised consent language
- [ ] Recruitment script
- [ ] Survey/instrument appendix
- [ ] Data dictionary
- [ ] AI/data-security appendix
- [ ] Screenshot or workflow diagram
- [ ] Other:

## 6. Human questions for PI/IRB team

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2.
3.