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Detroit VA Medical Center Research and Development Service

FORMS

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2009 Research and Development Application Link to MS Word Document for Research and Development Application

Note: This form must be submitted with all Research proposals.

 

Human Study Forms

VA Research Consent Form (10-1086) MS Word icon, link to VA Research Consent Form (10-1086-407) document

Consent Checklist MS Word icon, link to Consent Checklist document

* Human Investigation Committee (HIC) Forms CLICK HERE

VA Appendix for Continuation MS Word icon, link to VA Appendix for Continuation document

 

Safety Forms

VAF 10-0398 (Feb. 2007) Research Protocol Safety Survey MS Word icon, link to Research Protocol Safety Survey document

 

Animal Forms

Animal Component of Research Protocol-ACORP MS Word icon, link to Animal Component of Research Protocol-ACORP document

(WSU addendum must be submitted with ACORP form)

* Application To Use Vertebrate Animals for Research http://aic.wayne.edu/forms/AIC_VA_Protocol_Application_ACORP_Attachment.doc

 

Investigational Drug

VAF 10-9012 Investigational Drug Information Record MS Word icon, link to Investigational Drug Information Record document Adobe Acrobat icon, link to Investigational Drug Information Record PDF

 

Employment Forms

Optional Application for Federal Employment (OF-612) MS Word icon, link to Optional Application for Federal Employment (OF-612) document Adobe Acrobat icon, link to  Optional Application for Federal Employment (OF-612) document PDF

Declaration of Federal Employment (OF-306)Adobe Acrobat icon, link to  Declaration of Federal Employment (OF-306) PDF

Fingerprint MS Word icon, link to Questionnaire for Non-sensitive Position (SF-85) document

(Fingerprints will be taken by Police and Protection Service)

I-9 form Adobe Acrobat icon, link to  Optional Application for Federal Employment (OF-612) document PDF

WOC Information Sheet MS Word icon, link to WOC Information document Adobe Acrobat icon, link to WOC Information document PDF

WOC Application (must be renewed annually) MS Word icon, link to WOC Application document Adobe Acrobat icon, link to WOC Application document PDF

Resident WOC form MS Word icon, link to WOC Application document

If participating in human studies research:

Education Verification MS Word icon, link to Education Verification document Adobe Acrobat icon, link to Education Verification document PDF

Scope of Practice MS Word icon, link to Scope of Practice document Adobe Acrobat icon, link to Scope of Practice document PDF

Applicant Release MS Word icon, link to Applicant Release document Adobe Acrobat icon, link to Applicant Release document PDF

 
Intergovernmental Personnel:

Assignment Agreement - OF 69 (Rev 2-89) MS Word icon, link to Assignment Aggreement - OF 69 (Rev 2-89) document Adobe Acrobat icon, link to Assignment Agreement document PDF

 

Merit Review Submission Information

IMPORTANT: Please contact Detroit R&D Office at (313) 576-3430 for submission process.

Merit Review Submission Forms can be found at www.research.va.gov/funding/process/forms.cfm

General Forms

Application for Leave MS Word icon, link to Application for Leave document Adobe Acrobat icon, link to Application for Leave PDF

Computer Access Request MS Word icon, link to Computer Access Request document Adobe Acrobat icon, link to Computer Access Request PDF

Purchase Order MS Word icon, link to Purchase Order document

Reproduction Request MS Word icon, link to Reproduction Request document Adobe Acrobat icon, link to Reproduction Request Form PDF

Equipment Order MS Word icon, link to Equipment Order document Adobe Acrobat icon, link to Research Service Equipment Request Form PDF

VA Timecard MS Excel icon, link to VA Timecard speadsheet

Work Order Request MS Word icon, link to Work Order Requestdocument Adobe Acrobat icon, link to Work Order Request Form PDF

Key Request MS Word icon, link toKey Request document Adobe Acrobat icon, link to Key Request Form PDF