Edward Hines, Jr. VA Hospital

Guidance for Proposal/Project Submission

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Request to Conduct a Research Proposal/Project

• Research Proposal Submission Instructions (Checklist) 
• Request to Conduct a Research Proposal/Project PART I: Research and Development 

Institutional Review Board Submission Packet Forms

• Request for IRB Review
• Request for Expedited Review
• Continuing Review Submission Packet
• Request for an Exemption
• VA Research Consent Form Template (in lieu of VA Form 10-1086)
• Appendix G - Nuclear Medicine
• Appendix H - Pharmacy Service 
• Appendix H(1) - Hines VA Hospital Sponsored Research Drug Charges 
• Sample Recruitment Flyer
• Request for Dual Enrollment
• Request for Enrollment of Non-Veterans
• HIPAA Authorization Template
• Request for Waiver or Alteration of Informed Consent
• Requesting a Waiver or Alteration of HIPAA Authorization
• Privacy and Information Security Form/Checklist 

Institutional Review Board Guidance and Other Forms

• Guidance for Elements to be Included in a Research Protocol
• Amendment/Revision Reporting Form
• Non-local Adverse Event Reporting Form 
• Local SAE-UA Reporting Form 
• Notification of Monitor Visit Form
• Annual Credential Verification Form
• Radiology Review Form
• Laboratory Service Review Form
• IRB Standard Operating Procedures
• Investigational Drug Information Record
• Local Serious Adverse Event or Unanticipated Problem Log 

Institutional Animal Care and Use Forms

• Animal Component of Research Protocol (ACORP) for IACUC Review
• ACORP Appendix 1 - Use of a Non-VA Facility to House Animals Purchased with VA or VA Research And Education Corporation Funds
• ACORP Appendix 2 - Anitbody Production
• ACORP Appendix 3 - Test Substances
• ACORP Appendix 4 -  Antemortem Specimen Collection
• ACORP Appendix 5 - Surgery
• ACORP Appendix 6 - Special Husbandry and Procedures
• ACORP Appendix 9 - Additional Local Information
• Additional Personnel Form
• Annual Review
• Modification Form

Research Safety Forms

• Research Safety Subcommittee Part II Form (Hines)
• Research Safety Subcommittee Part II Form (Lovell)
• Annual Review Form 
• Modification Form 

Miscellaneous Forms for Budget and Travel

• SF182 - Request, Authorization, Agreement and Certification of Training
• Research Supplies Order Form
• VA Form 0893 Support for Official Travel (replaces 10-01016) 
• Equipment Turn-In Request Form 
• Motor Vehicle Request Form