UW Directories | Calendar | Map | MyUW
UW logo
Skip to Main
Human Subjects Division (HSD)


Document Details

Last Updated 11/01/2013
Version 2.70
Filesize 2.44 MB
Audiences Researcher
Doc Type Form
Use of HSD PDF Forms

HSD Forms are compatible with Adobe Reader, Version 8.1 and higher, though we recommend use of the most recent version. You may receive messages from Adobe to upgrade.

For Mac users: be sure to open the form in Adobe Reader or Acrobat.

download Adobe Reader

APPLICATION: Determination, Exempt Status (PDF)


The Exempt Status Request has been converted to PDF and combined with portions of the guidance document.

The purpose of this form is to provide the UW Human Subjects Division staff with the necessary information to determine if a research activity involving human subjects may be eligible for a determination of “exempt” status, as allowable by the regulations that govern human subjects protections.

The Word version of this document is linked below.

Change Notes

  • Related to Ver. 2.70, noted 11/01/2013 @ 02:20pm
    Updated instructions. Okay to use previous version.
    - sherrye
  • Related to Ver. 2.60, noted 10/19/2013 @ 04:39pm
    Updated name to new naming convention on website.
    - sherrye
  • Related to Ver. 2.60, noted 06/28/2013 @ 11:55am
    Updated to align with new SOP. Please use latest version of this form.
    - sherrye
  • Related to Ver. 2.50, noted 05/31/2013 @ 09:45am
    Updated mailing address information. Okay to use previous version.
    - sherrye
  • Related to Ver. 2.40, noted 04/26/2013 @ 11:41am
    The title and position fields have been separated in the contact information section. Okay to use previous version.
    - sherrye
  • Related to Ver. 2.30, noted 01/25/2013 @ 09:09am
    Updated FCOI language. Okay to use previous version.
    - sherrye
  • Related to Ver. 2.20, noted 11/30/2012 @ 08:46am
    Instructional text added to Category 4: Existing Data. Okay to use previous version until 12/31/2012.
    - sherrye
  • Related to Ver. 2.10, noted 06/22/2012 @ 08:42am
    Removed line from Chair signature assurance that stated: I certify that this research has received an intramural review and approval of scientific merit, if it did not go through an extramural review process.
    - sherrye
  • Related to Ver. 2.00, noted 05/25/2012 @ 09:07am
    New questions added for Lead Researcher. Do not use older versions of this form. HSD will not accept older versions after July 1, 2012.
    - sherrye
  • Related to Ver. 1.50, noted 01/27/2012 @ 08:47am
    Updated signature policy, okay to use previous version.
    - sherrye
  • Related to Ver. 1.30, noted 11/30/2011 @ 04:03pm
    Addition of the term survey to the guidance within the form.
    - sherrye
  • Related to Ver. 1.20, noted 05/27/2011 @ 09:54am
    Addition of double-sided copies instructions.
    - sherrye
  • Related to Ver. 1.10, noted 05/06/2011 @ 01:08pm
    Form is no longer in beta-test. Updated to force open guidance sections to close before printing.
    - sherrye
  • Related to Ver. 1.00, noted 03/23/2011 @ 09:14am
    Document newly added.
    - sherrye