VA Research Forms

Research & Sponsored Programs

Vice Chancellor's Office

Research & Sponsored Programs

Research
Compliance

Sponsored Research Services

SRS-Award Services

Funding
Information

Proposal
Development

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VA Research Project Submission Checklist

States policy of R&D Committee for research approval.
Gives basic directions for completion of all forms.
Lists sites where forms can be found.
Denotes where items should be sent.
Lists all forms

Investigator Data Sheet

VA Form 10-5368
Department of Veterans Affairs IT format for each new investigator.

Project Data Sheet

VA Form 10-1436
Department of Veterans Affairs IT format for each new project.

VA Data Security Appendix (C-D)

VA R&D Committee Research Study Submission Form

Specific to Roudebush VAMC to provide additional information to help the Committee determine appropriateness of project for unique population and facility.

VA Consent Form

VA Form 10-1086
Department of Veterans Affairs format for Informed Consent with suggested wording taken from the IUPUI RCA’s informed consent template including specific wording for “Research Subject Costs” and a contact number for the VA Customer Service Office.

Investigational Drug Information Record

VA Form 10-9012
Department of Veterans Affairs format for providing communication between the PI and VA Pharmacy.
Requires signed approval by the IRB and R&D Committee chairpersons.

Research Protocol Safety Evaluation

VA Form 10-0398
Department of Veterans Affairs format to obtain information pertaining to laboratory practices in “wet labs” at the VA used for research specimens.
Must be completed for all VA funded research.

Pathology and Laboratory Impact Estimation Worksheet

Local form to provide a standard communication tool between the PI and laboratory services.

Research & Sponsored Programs
Last Update: April 9, 2008
http://www.research.iupui.edu/spon/va_forms.htm
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