Forms - Ralph H. Johnson VA Health Care System
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Ralph H. Johnson VA Health Care System

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Forms

Click on the tabs below to find the appropriate research forms.

Getting Started

REQUIRED Forms

eIRB

IACUC

SRS

General Information

  • Getting Started
  • Flow Chart
  • Training Requirements – Under construction
  • Core equipment available at RHJ VAMC – Under construction

Research and Development Committee Forms *All forms below are Required for All Submissions

Institutional Animal Care and Use Committee (IACUC)

 

 



 


 

Institutional Review Board (IRB) and Studies Involving Human Subjects


New! VA Informed Consent (guideline and template attached)
VA Consent to use Picture and/or Voice Recordings (form attached)
or
Waiver Request Form

VA HIPAA Authorization Form (*NEW VA guideline and template attached)
Investigational Drug Information Record (10-9012)

Institutional Animal Care and Use Committee (IACUC)

Animal Component of Research Protocol (ACORP)
ACORP Amendment New
Request for Deviation in Standard Operating Procedures for Husbandry
Annual ACORP Renewal New
Suggested Literature Search Options New
Preventive Medicine Program Statement New

Research Biosafety Committee

Research Biosafety Submission Form
Research Biosafety Annual Renewal Form
SRS Ternination Form

New SRS Protocol Amendment Form

Please contact Ryan Kelly, PhD, Chair of SRS-IBC for questions concerning submisison packet.

Travel Forms

Travel within the United States
Policy-acceptance of funds
Reimbursement from a 501(c)(3)
Request to travel
Request to accept travel funds
Leave request

Foreign Travel
Foreign travel policy
Acceptance of funds policy
Foreign travel request
Passport request
Request to accept travel funds
Request to accept travel funds-regional consel
Reimbursement from a 501(c)(3) organization
Leave request

Without Compensation (WOC) Application Packet

New WOC Packet Please contact Charles Holloman for more additional questions at (843) 789-6703 or charles.holloman@va.gov

VA/MUSC Memorandum of Understanding (MOU) Template

MUSC/VA MOU template (Please contact Sarah Jackson for template)