United States Department of Veterans Affairs
United States Department of Veterans Affairs

Brooklyn Campus of the VA New York Harbor Healthcare System

Research and Development Program

GUIDE TO THE INVESTIGATOR: INITIAL STUDY PACKAGE
General Information
Research Staff Training Checklist
Authorization to Transport and Utilize VA Sensitive Information Outside Protected Environments
Principal Investigator Checklist for Initial IRB Submissions
Tissue Banking Requirements
Funding Source Codes
Abstract Guidelines
Guidance on Research Studies Using Investigational Drugs
• Investigational Drug Management Fees (see office secretary)
Codes & Instructions for Investigator Data Sheet
Appendix C (Data Security Checklist for Principal Investigators ) & D (Principal Investigator’s Certification: Storage& Security of VA Research Information)

REQUEST TO REVIEW INITIAL STUDY PACKAGE
Conflict of Interest Disclosure Form
Request to Review Research Proposal/Project
Pharmacy Support Form
Budget Form: Non-VA Research Funding
pg 18 - Investigator Data
Form 10-9012, Investigational Drug Information Record

HUMAN STUDIES FORMS
VAF 10-1086, VA Research Consent Form
Human Studies Questionnaire (HSQ)
HSQ without Supplement Pages
HSQ Supplement IIHI Use
HSQ Supplement Investigative Device
HSQ Supplement IRB Waiver 1
HSQ Supplement IRB Waiver 2
HSQ Supplement IRB Waiver 3
Human Studies Questionnaire Sample Answers
Protocol Amendment IRB Submission Form
Human Subject Enrollment Log
Research Coordinator Scope of Practice
Research Coordinator Scope of Practice (Non-VA Paid)
Application for an Off-Site Tissue Banking Waiver
Certification of Compliance with HIPAA Privacy Rule Requirements for Use of PHI Preparatory To Research

ANIMAL STUDIES/IACUC FORMS
Animal Component of Research Protocol (ACORP)
ACORP Appendix 1 - NON-VA Animal Facility
ACORP Appendix 2 - Antibody Production
ACORP Appendix 3 - Test Substances
ACORP Appendix 4 - Antemortem Specimen Collection
ACORP Appendix 5 - Surgery
ACORP Appendix 6 - Special Husbandry & Procedures
ACORP Appendix 7 - Request to Use Pt Care Procedural Areas
ACORP Appendix 8 - Request to Use Explosive Agents
ACORP Appendix 9 - Additional Local Information

RESEARCH SAFETY SUBCOMMITTEE FORMS
VA Biohazard & Safety Information Form

ANNUAL REVIEW IRB FORMS: HUMAN STUDIES
IRB Continuing Review Checklist
VAF 10-1086, VA Research Consent Form
Adverse Event Report
Request for Continued Approval of Human Use Form
Research Staff Training Checklist

ADDITIONAL R&D FORMS
Informed Consent Checklist
Informed Consent Template
Request for Expedited Review
Certification of Exemption
Addition of Research Personnel
Application for Case Report Review
Request for Study Closure

COMMITTEE FORMS
IRB Initial Review Checklist
IRB Continuing Review Checklist
RD Initial Review Checklist
RD Continuing Review Checklist


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