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VA R & D Submission Forms:

The VA forms have been updated to Acrobat 6, please update your free copy of Acrobat Reader to utilize and save the forms:  (You may need to uninstall the old Acrobat Reader first.) Acrobat Reader:  http://www.adobe.com/products/acrobat/readstep2.html
     


Contact: for
VA R & D Submission  

Name Lena Molen

Email

lena.molen@va.gov

Address

VA Medical Research and Development (151-CDD) mail sort 2142

Address

C-404 Cooper Drive

Phone

859 233-4511-4281

Fax

859 281-4989

     
Diagnosis Code Contact:
 
Name David B. Adkins

Email

david.adkins@va.gov
Title DSS Clinical Coordinator

Address

VAMC A136-01 Cooper Drive

Phone

859 381-5138
Fax 859 281-4988
     


Administrative Officer:

Name Carolyn Brown, Administrative Officer
Email carolyn.brown3@va.gov
Department VA Medical Center Research and Development (151-CDD) mail sort 2142
Address C403b-Cooper Drive
Phone (859) 381-5947
Fax (859) 281-4989
     


Annual VA Research Education Requirements
Personnel listed on attachment "A" of the VA submission must complete yearly VA education requirement and have WOC (without compensation) status.

Register and complete the CITI course in The Protection of Human Research Subjects (www.citiprogram.org).  Upon completion of the course, send or fax a copy of your CITI certificate to Debie Hayse, VA Research Office (151), Room C-403, 859-281-4927,
Fax 281-4989.

Security Agreement
VA-Submission Guidelines
Attachment B-DSS
Attachment B-Mental Health

Appendix F
Sensitive VA Healthcare Information in Research Assurance
Request for a VA Research Chemical Pickup

VA Submission Process Guidelines

Initiating a Clinical Study at the VA (FAQ)

VA HIPAA Authorization Updated!

In order for the IRB to consider approval for a protocol falling under the VA’s purview, the following materials and details must be included in the IRB application submission.

  • VA Form 10-1223 Report of Subcommittee on Human Studies. The PI should fill in the project/program title, PI name, and VAMC name at the top of this form. The IRB/ORI
    staff will complete the "Committee Findings" section.
  • If the requirement for documentation of informed consent has not been waived, all
    VA research protocols must include a VA-specific consent form (VA 10-1086).
  • All VA studies must have " UK/VA:" at the beginning of the study title (for internal tracking purposes).

(10-1436) Research and Development Information System Project Data Sheet 

(10-9012 Side 1) Investigational Drug Information Record

(10-9012 Side 2) Original completed memo, entitled Research "Proposal involving Drugs...Or Investigational Devices"

VA Subcommittee on Research Safety (SRS) Form: Research Protocol Safety Survey Note: Please use this version of the Subcommittee on Research Safety (SRS) form only.  The version from the va.gov Web site will not be accepted. You will need 15 copies of the protocol and the Subcommittee on Research Safety (SRS) Form.

Attachment A and B

Consent Form Attachment

VA Research Consent Form

Informed Consent for Protocols Involving Tissue Banking

New Investigator (only) 10-5368

     


VA Animal Study Forms: 

ACORP Appendix 1:  Use of Non-VA Animal Facility

ACORP Appendix 2:  Antibody Production

ACORP Appendix 3:  Test Substances

ACORP Appendix 4:  Antemortem Specimen Collection

ACORP Appendix 5: Surgery

ACORP Appendix  6: Special Husbandry and Procedures

ACORP Appendix 7: Request to Use Patient Care Procedures Areas for Animal Studies

ACORP Appendix 8: Explosive Agents

ACORP Appendix 9: Local Use Information

ACORP Consultation Page

ACORP Main Body Page

ACORP Modification

ACORP Sign off

  Comments to Roxane Poskin, Last Modified: March 03, 2008
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