FORMS

INSTRUCTIONS

IRB

Required  Cover Page, Page1, Page2, Page3 

Letter of Support Lab Service (if applicable)

Letter of Support Imaging (if applicable)

For new investigators: Page 18

Funding source codes & Administrative Codes

Codes for Investigator's Profile (Page 18)

 Check List for Human Studies

 No. of copies Needed  IRB Calendar 2005

IRB Calendar 2007  2008

IRB Statistics 2005     Last 12 months

IRB Members Roster 2004  2005   2006 2006-late  2007

Application for review of research 

IRB Meeting Regulatory Check List

Application for review animals or science only initial

Application for review animals or science only continuation

Committee Submission Deadlines and Meeting Dates

How to write a proposal (1201.1 Handbook)

Drug Information Form 10-9012

Investigation Device Supplemental Application

Consent Form 10-1086 with Surrogate

Consent Form 10-1086   last changes tracked

Procedure for use  Readability Tips

Consent Log

SECURITY

PHI Disclosure Report

Application and Check List C&D

Authorization to transport/utilize sensitive information outside VANJHCS protected environment and Request for IRM provided equipment 

Application Take Data from VA form

Data transfer Agreement to another VA  

Data Transfer Agreement non-VA

Device inventory

PHI Disclosure Report Memo

Diminished Capacity Form

Procedure for use

HIPAA consent   (attachment A)

HIPPA Waiver request                           

HIPAA mandate  

Investigator's Responsibility Agreement

.

Request for Pharmacy Support

Instructions for request to Pharmacy

ORD Mandate for FHPP Support $1200

Investigator's Personal Financial Disclosure

.

Amendment Request

.

IRB Continuing/ Study Closure Form

IRB Continuing/ Study Closure Form Tracked

IRB Continuing Scope of Practice Form

.

Event/Problem Report Form

Non-Vet 10-10EZ Form for Registration (2005)

Procedures for Non-Vets

Off Site Research Application Form

Instructions for Off Site Application

Merit Review         VA Research Forms

CRADA-CT template

CRADA Guidelines

DHHS forms

IRB Reviewer Tools

IRB DMC Reviewer Form

IRB Emergency Use Reviewer Form

IRB Meeting Regulatory Check List

IRB Initial Review Form

IRB Continuing Review Form

IRB Amendment Reviewer Form

IRB / R&D Members Conflict of Interest Form

IRB Review for Noncompliance Form

IRB Ad Hoc Reviewer Conflict of Interest Disclosure

IUCAC

NJ Health Care VA ACORP Forms: main 1 2 3 4 5 6 7 8 9 (must use after Jan 1, 2005)

SAFETY & SECURITY

Safety Form   ComputerSurveyForm

EMPLOYEE REQUIREMENTS

.WOC Orientation Checklist    WOC Certification   [Scope of Practice + CV+copy of licenses] .

VBRI

Visit http://www.vbri.org/forms.htm