INSTRUCTIONS AND EXAMPLE:

Letter of Permission for Use of Data/Samples

When is a letter of permission required? A letter of permission is typically required when using data/samples owned by
another individual.

Who writes the letter? Letters of permission are typically written and signed by the individual who owns the data or who
otherwise has the authority to share the data. The letter should be printed on the data owner’s letterhead.

What information should the letter include? The content of a typical letter is summarized below. However, not all
information is required for all projects, and some projects may require additional information. If you have questions about
the content of this letter, please contact Rebecca Novak at Rebecca.Novak@uth.tmc.edu or Dr. Laura Mitchell at
Laura.E.Mitchel@uth.tmc.edu.

MEMORANDUM
DATE: <Today’s date>
TO: <Anne Dougherty, MD
Chair, UT Committee for the Protection of Human Subjects>
FROM: <Data owner’s name, title, and contact information>

SIGNATURE:
RE: PERMISSION FOR USE OF DATA/SAMPLES

The data owner should:

 indicate that s/he gives the student permission to analyze the data (or samples) collected
during the project, “original project name,” expressly for the CE/thesis/dissertation project
titled, “student’s project name.”

 explain whether there are identifying variables in the parent data set, and if so, whether or not
the student will be given access to identifiers.

 indicate whether data were collected with the approval of an Institutional Review Board (IRB).
For data collected within UTHSC, list the original study’s CPHS approval number (HSC-SPH-__-
____). For data collected outside of UTHSC, provide a copy of the study’s IRB approval letter.

 indicate whether the student is part of or will be added to an active UT-Committee for the
Protection of Human Subjects (CPHS) protocol and, if so, provide appropriate documentation
(e.g. a copy of the CPHS letter of approval for personnel changes). (For more information on
adding a student to a UT CPHS protocol, please see the Research Compliance Guide at:
https://sph.uth.tmc.edu/content/uploads/2011/12/RESEARCH-COMPLIANCE_v1-1-Apr-2011.pdf )

Fall 2012