Attached are the forms to be submitted together with your manuscript, survey instruments and other

pertinent documents, if applicable:

Please note that your MANUSCRIPT/PAPER/RESEARCH PROPOSAL

is what we consider as PROTOCOL

PROTOCOL PACKAGE CHECKLIST (F-30)

This serves as your checklist. Those marked under “YES” column are the mandatory requirements. Please
mark the "NO or NA" column if it is not applicable to your study.

1.) Processing Fee – I will send a billing statement once the Chair determines the type of review for your
protocol.

2.) Cover letter - Please address your letter to:

Ruby S. Suazo, Ph.D.

Chair
Research Ethics Committee
University of San Carlos

The letter should contain a brief background of your study and your intention to apply for ethics review.
Please discuss the need for human participants in your study and who your participants are. The
letter should be signed by all researchers and noted by your adviser (if applicable). Both should be
fresh signatures but because of the current situation, electronic signature(s) of the researcher(s) and
adviser is acceptable provided that you ask for permission.

3.) Research Protocol Application form (F-32) - Please fill up the form. The "date of submission" is the
date you submit to REC. For the "proposed start date" - just an estimate (4 weeks from submission to
REC). Print then sign (fresh signature(s)) and date.

Electronic signature(s) is acceptable for now.

4.) Data Privacy Consent Form (F-34) – Please read carefully then print and sign (fresh signature(s))
and date.

You can insert electronic signature(s) for now then save as PDF.
5.) Capsule Proposal Template (F-31) – It is very important that you fill this up properly and
religiously because this is one of the basis for the initial assessment of the REC Chair. Please
retain the number and heading of each assessment point. i.e.:

INTRODUCTION

1. Scientific background/context
< entry >

2. Rationale/Significance, etc.
< entry >
…….
5. Justification ….
< entry >

METHODOLOGY

1. Research/Study design
< entry >

2. Research setting/environment, etc.

< entry >

.......

13. Brief but sufficient description of the conduct

Please do not leave anything blank. Please indicate "NONE/NA" to an assessment whichever is
applicable if this is not found in your manuscript. We also need a brief explanation as to why you
indicate "None/NA".

6.) Protocol Review Assessment Form (F-22) - Your manuscript is your Protocol. Please fill up the
shaded area only. Please provide the page number (and paragraph number if possible). Please DO NOT
fill up the "YES, NO ... Explanation" column - this is for the reviewer only. ALL ITEMS SHOULD BE
ANSWERED. If it is not found in your manuscript, please write "NA" in the shaded area.

e.g.

1.1. Is/Are the main research question(s) reasonable? Provide the page number of your Statement of the
Problem

1.2. Are the study objectives specific, measurable, attainable, and reasonable based on the research
instrument(s) presented? Page number where your objectives of the study can be found

1.3. Is/Are the research instrument(s)/data collection tool(s) adopted from existing one(s) and has the
developer’s consent for its usage in the study? Page number where you discuss your research instrument
in your Methodology.
1.4. Does the protocol present sufficient background information or results of previous studies that merit
the involvement of human participants? This is the page number of your Review of Related Literature

Please note that the page numbers you declared in F-22 is strictly from your manuscript/thesis paper and
NOT from your Informed Consent Form except the CVs of researchers and adviser which is an Appendix.

Please take note of B3. Data Protection Plan. Since we are upholding the Data Privacy Act in the
Philippines, the reviewers would always look into your data management plan in your methodology. A
paragraph or two discussing your Data Management Plan (DMP) is advisable.

Questions that you need to address in your DMP:

1. Where will you save your encoded data? Is it password protected? Who can access your
laptop/computer?

2. Are the names of the respondents coded to protect their privacy?

3. How long will you store the soft and hard copies? (The reviewer suggests that you keep it for a
minimum of three years - so if you plan to present it in a conference or publish it and if someone would
question the validity of your study then you still have the documents to prove it.)

4. As for the hard copies, is the questionnaire coded? I suggest that instead of "Name (optional)" in the
questionnaire - it should be Respondent No. ______ so that the questionnaire will not be traceable to the
respondent. Anyway, it is in the Informed Consent that the respondent's name can be found. You just have
to add "Respondent No.___ also in your Informed Consent. So if the respondent agrees to answer your
questionnaire, then you will be the one to provide the unique respondent number so that you can still
trace who answers this particular questionnaire.

5. Where will the hard copies be stored? (It should be stored in a cabinet with lock and key that only the
researcher and adviser can access) Where is this cabinet placed? It should be explicit.

6. Method of disposal? (Hard delete may be recommended for the soft copies while it is recommended
that the hard copies be shredded not burned.)

Please refer to assessment points 3.1 to 3.10 under 3. DATA PROTECTION PLAN of F-22.

7.) Informed Consent Form Checklist (F-23) - Please fill up the shaded area starting from item no. 1.1
to 1.18 with the page and paragraph number. Please DO NOT fill up the "YES, NO ... Explanation"
column - this is for the reviewer only. ALL ITEMS SHOULD BE ANSWERED. If it is not found in
your Informed Consent Form, please write "NA".

Please note that the page number you declared in F-23 is strictly the page number from your Informed
Consent Form and NOT from your manuscript. If your respondents are ordinary household members, it is
advisable that you also submit a translated version of your Informed Consent Form in the local dialect of
your respondents.

It is advisable to use the sample Informed Consent Form since all the essential points are there. What
you discussed in your Informed Consent Form should also be discussed explicitly in your manuscript
for consistency. Your Data management plan in your methodology can be incorporated in your Informed
Consent Form to assure the respondents of their confidentiality.

8.) Detailed Budget Sheet (F-33) - please indicate the name of the funding source (under Source A)
whether it is personal or a grant.

Example:

D1 Sources of Funds and Amount (PhP)

External
Particulars Internal
Personal Source* TOTAL
Source*
[ DOST ]
I. Personnel Services (PS)
a. Salaries
b. Honoraria
Honorarium for Statistician 1,000.00 1,000.00
Sub-total for PS 1,000.00 1,000.00
II. Maintenance and Other Operating Expenses (MOOE)
a. Traveling expenses
USC to Site A vice versa (11.00 x 2) 22.00 22.00
USC to Site B vice versa (11.00 x 2) 22.00 22.00
b. Supplies and materials expenses
Bond paper (1 ream) 500.00 500.00
Photocopying (12 pages x 120 copies x PhP
1.50/copy)
2,160.00 2,160.00
c. Incentive for the respondent
Token (PhP 50.00 x 120 respondents) 6,000.00 6,000.00
d. Ethics Review Fee 1,000.00 1,000.00
Sub-total for MOOE 1,044.00 8,660.00 9,704.00
III. Capital Outlay

Sub-total for Capital Outlay

IV. Administrative Cost

GRAND TOTAL 2,044.00 8,660.00 10,704.00

NO CAPITAL OUTLAY AND ADMINISTRATIVE COST (for undergraduate/graduate studies).

Don’t forget the Grand Total

9.) Curriculum Vitae - please submit your latest CV. It should include trainings, seminars attended and
previous researches conducted not just your educational background. On the last page of your CV please
incorporate something like:

I certify that all of the above information are true and correct. This should be signed and dated.
We also require for the CV of your adviser. This should also be dated and signed.
10.) Document Receipt Form (DRF) (F 29) - this is basically just the same as your protocol package
checklist. What you marked under YES, NO or NA in your Protocol Package Checklist should also be
marked in your DRF.

As a summary, your application should be in this order:

1. USC REC F-29 - Document Receipt Form (in word format)

2. USC REC F-30 - Protocol Package Checklist (in word format)
3. Cover Letter (in PDF format)
4. USC REC F-32 - Research Protocol Application Form (in word format)
5. USC REC F-34 - Data Privacy Consent Form (in PDF format)
6. USC REC F-31 - Capsule Proposal Template (in PDF format)
7. USC REC F-22 - Protocol Review Assessment Form (in word format)
8. USC REC F-23 - Informed Consent Form Assessment Checklist (in word format)
9. Your thesis/manuscript, including the following as an Appendix: (in PDF format)
a. Informed Consent Form (if applicable);
b. Questionnaire / instrument (if applicable);
c. USC REC F-33 - Detailed Budget Sheet;
d. CVs of researcher(s);
e. CV of adviser (if applicable); and
f. Other supporting documents like transmittal/communication letters, etc.

Please DO NOT RENAME the REC forms.

Please don’t create separate files for Informed Consent Form, instruments/questionnaires and CVs as
these may create confusion.

USC REC will only accept APPROVED proposals (have incorporated all the comments and
recommendations from the technical panel of the School/Department)

For instruments/questionnaires being used, it is highly advisable to ask permission from the author
since this is a copyrighted material. This can be one of your supporting documents.

If you have any questions, please feel free to send an email or call us at 254-7742. Thank you very much.

All the best,

JJ Masna for USC REC