United States Department of Veterans Affairs

Ralph H. Johnson VA Medical Center

For Investigators: Committees - Forms

VA Central Office:
VA Forms, Including 1313 Forms for Merit-Review Applications
 

Research and Development (R&D) Committee:
Submission Packet - Request to Review Research Projects Updated 5-2-2013 
 

Institutional Review Board (IRB) and Studies Involving Human Subjects:
Request to Review Research Proposal-Project (same as “Request to Review” form used for the R&D Committee) Updated 5-2-2013 
Electronic submission 
VA Informed Consent for ERMA submissions (guideline and template attached)
VA Informed Consent for eIRB submissions (guideline and template attached)
VA Consent to use Picture and/or Voice Recordings (form attached)
  or
Waiver Request Form 

VA HIPAA Authorization Form for ERMA submissions (guideline and template attached)
VA HIPAA Authorization Form for eIRB submissions (guideline and template attached)

  or
HIPAA Waiver of Authorization Form 

Investigational Drug Information Record  (10-9012)
 

Institutional Animal Care and Use Committee (IACUC):
Animal Component of Research Protocol  (ACORP)
ACORP Amendment 
Request for Deviation in Standard Operating Procedures for Husbandry
Annual ACORP Renewal 
Suggested Literature Search Options New 
 

Research Biosafety Committee:
Research Biosafety Submission Form 
Research Biosafety Annual Renewal Form 

Travel Forms:
Travel within the U.S. 
Foreign Travel 
 

Without compensation (WOC) application packet:
WOC packet  updated 8/18/2011

VA/MUSC memorandum of understanding (MOU) template:
MUSC/VA MOU template 

M. Rita I. Young, Ph.D.
Associate Chief of Staff for Research
E-mail:  rita.young@va.gov
Phone: (843) 789-6707;  Fax: (843) 876-5384
Research Service
Ralph H. Johnson VA Medical Center
109 Bee Street
Charleston, SC  29401

 

 
Useful Research Links

Charleston VA Research Home 

 

Our Research Program 

 

For Investigators 

 

Charleston Research Institute 

 

For Veterans Interested in Participating in Research