Forms

SCIRE

Checklist and Instructions Submission Checklist  Instructions (Rev. April 03, 2007)

	Security Requirements for VA Research Information Certification by Principal Investigators Security Requirements for VA Research Information Appendix C Appendix D VA Research Data Security & Privacy Web Course log on instruction for VA Employee VA Research Data Security & Privacy Web Course for  NON-VA Employee
	Impact Estimation (new projects) Click here for Unit Cost Estimation Table) Impact Estimation Worksheet Laboratory  03/31/2008 Impact Estimation Worksheet Pharmacy   03/31/2008 Impact Estimation Worksheet Radiology   03/31/2008
	General Forms Guidelines For Narrative Description of Proposed Research R&D Prospectus of Research Study Form VAF 10-1436 Project Data Sheet and Abstract
	Disclosure of Interest Requirements Disclosure of Relationships and Financial Interests VA Technology Transfer Forms
	Safety (new & continuing) Research Protocol Safety Survey (VAF 10-0398)

	Radiation Use Application for Radiation Film Badge Application for Radioisotope Use Radioactive Waste Sewer Disposal Log Radioisotope Possession Disposal Log Request for Acquisition of Radioactive Materials Weekly Monthly Area Radiation Survey Weekly Monthly Wipe Test Record
	Merit Review 0-1313-1 Form (Merit Review Application) 10-1313-2 Form (Summary Description of Program and Project) 10-1313-3 Form (Current Funds and First Year Request) 10-1313-4 Form (Estimate of Project Expenses) 10-1313-5_6 Form (Investigator's Biographical Sketch) 10-1313-7 Form (Investigator's Total VA and Non-VA Funding) 10-1313-8 Form (Total VA and Non-VA R&D Support) 10-1313-13 (VHA R&D Career Development Letter of Intent Cover Page)(09/22/06) Instructions for Submitting a Career Development Letter of Intent(09/22/06) DRAFT VHA Handbook 1202.1 Merit Award Program for BLR&D/CSR&D (June 8th, 2006) Merit Review Entry Program (MREP) (January 2005) Suggested Merit Review Board Memo Reviewer Suggestions by PI Merit Review Submission Deadlines for Calendar Year 2007
	For Reviewers R&D Committee Project Review (Primary Reviewer's Comments)

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Project Submissions   Human Studies Training & Credentialing Release of Information Form Scope of Practice Form CITI Training Instructions Application & Form Criteria for Expedited Review Worksheet Exempt Eligibility Determination Form Application for IRB Review Application for IRB Review Supplement Investigational Drug Information Investigational Device Plan Informed Consent Guidance and Template (VA Form 10-1086) Waiver of Consent and Authorization Request Form   HIPAA Forms HIPAA Authorization HIPAA Physician Referral Authorization HIPAA Physician Referral Revocation HIPAA Revocation HIPAA Waiver for Screening and Recruitment HIPAA Waiver of Authorization   Investigational Drug Information Record (VAF 10-9012) Application for Continuing Review (06/12/07) IRB Request for Modification

	Documentation & Reporting Standardized Template for CPRS Notes Unanticipated Problems & Deviation Notification Non-local Adverse Event Notification Local Serious or Unexpected Adverse Event Notification Pre-audit Questionnaire Enrollment of Non-Veterans
	For Reviewers IRB Pre Reviewer Worksheets IRB Reviewer Worksheets for New Projects IRB Reviewer Worksheets for Continuing Projects IRB Reviewer Worksheets for Informed Consent (ICF)/HIPAA Authorization Expedited Review Criteria Worksheet IRB Meeting Discussion Worksheets
	Study Monitor Visits Procedures for Visiting Study Monitors 2-21-2007 Study Monitor Instructions Study Monitor Follow-up Memo

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	Project Submission Animal Component of Research Protocol (ACORP) Occ Med Questionnaire (e-version) Annual Health Surveillance Questionnaire for Personnel Working with Laboratory Animals Notification of Multiple Use of an Anesthetized Animal IACUC Annual Progress Report 2007   Request to Modify Animal Use
	Other Reviewer Worksheet for Annual Progress Report Animal Order Form Hardcopy Experimental Surgical Record Memo Notification of Transfer of Organ-Tissue-Blood of Euthanized Animal to Approved Investigator Ordering Controlled Substances - Vista Instructions Research Weekly Count Log Research Log For Green Sheets

 

Employee (New and WOC) VA Research Data Security and Privacy Training Course Instructions WOC Appointment Request Form Employee Risk Assessment Human Resource Appointment Memo Appointment Affidavits (SF-61) Continuation Sheet for Questionnaires (SF-86a) Declaration for Federal Employment (OF 306) Employment Eligibility Verification Form I-9 Optional Application for Federal Employment OF 612 Questionnaire for Non Sensitive Positions (SF-85) VA-WOC Appointee Intellectual Property Agreement VAF 5578 Applicant's Statement of Selective Service Registration Status Automated Information Systems (AIS) Security Access Notice and Statement of Understanding Fingerprinting Verification Request for Staff to Access Research Secured Area (Attachment A) Request for Staff to Access Research Secured Area (Attachment B)

Training & Credentialing Request, Authorization, and Certification of Training (In Lieu of SF 182) Education Confirmation Form Education Verification Instructions Phone Verification of Education Release of Information Form Sample Letter to Schools Scope of Practice Form CITI Course Instructions VA Research DATA Security and Privacy Web Course Instructions

SCIRE

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Travel Travel Voucher (Automated Standard Form-ASF 1012) Request for Approval of Acceptance of Gifts or Donations or Travel/Subsistence Expenses in connection with Official Travel VHA Faculty Employee (VAF 10-0101b) Claim for Reimbursement for Expenditures  on Official Business (ASF 1164)