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
VA ORO Final Report 

Research and Development (R&D) Committee:

Submission Packet - Request to Review Research Projects Updated 4-04-2014 
*New VA form 450, Financial Conflict of Interest (Required document for R&D submission)

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 4-04-2014 
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)
Waiver Request Form 

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

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 Sept. 17, 2014

VA/MUSC memorandum of understanding (MOU) template:

MUSC/VA MOU template (*New template coming soon)

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