EBIRE - East Bay Institute for Research and Education

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Resources :: Forms

Notice:ALL SUMISSIONS TO RESEARCH SERVICE MUST UTILIZE THE FORM VERSIONS LISTED BELOW EFFECTIVE JANUARY 1, 2009.
Note: Research Service will return applications on previous form versions without review.
Print completed submission, sign, and mail originals to Research Service.
Processing and review begins with receipt of hard copy.
Note: Electronic copies do not constitute a valid submission.

All EBIRE administered studies must be approved by the VA Research and Development committee (with prior approvl by appropriate subcommittees). Contact Errol Ingram, (916) 366-5340 for additional information.

VA Research Contacts

Errol Ingram
Administrative Officer
(916) 366-5340

Laura L. Jones, C.I.P.
IRB Administrator
(916) 366-5333

Tyra Simons
Assistant R&D Coordinator
(916) 843-7327

VA Forms - Instructions: Select a category to view all related forms.

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Important Information
- Important Information for Researchers (Coming Soon)
ACORP Animal
Amendment
- Amendment
Closure
- 0 - Closure Checklist
- 1 - Application for Study Closure
- 2a - Project Data Sheet (VA Form 10-1436)
- 2b - Project Data Sheet (VA Form 10-1436) - Instructions
- 3 - Research Data Security
- 4 -Human Subject Enrollment
- 5 - SAE/AE Spreadsheet Summary (Coming Soon)
Continuing Review
- 0 - Continuing Review Submission Checklist
- 1a - Research Protocol Safety Survey (SRS)
- 1b - Research Protocol Safety Survey (SRS) - Instructions
- 2 - Application for Continuing Review
- 3a - Project Data Sheet (VA Form 10-1436)
- 3b - Poject Data Sheet Instructions
- 4 - Human Subject Enrollment Form
- 5 - VA Research Consent Form and HIPAA Authorization (VA Form 10-1086)
- 6a - Request to Waive Consent and Authorization
- 6b - Request to Waive Consent and Authorization Instructions
- (Downlaod Sample Chart Review Waiver) (Coming Soon)
- (Downlaod Sample Pre-Screening Recruitment Waiver) (Coming Soon)
- 7 - MRI-fMRI Application
- 8 - Radiation Safety Application
- 9 - Research Data Security
- 10a - Recruitment Flyers � Advertisements
- 10b - Questionnaire Cover Letter
- 11 - SAE/AE Spreadsheet Summary (Coming Soon)
- 12 - Conflict of Interest Statement (VA Form 10-1313-14)
- 13 - Capacity Assessment Checklist for Research Informed Consent
New Study
Research
- Important Information for Researchers � Recruiting Human Subjects (Coming Soon)
Research Meeting Review and Submission Schedule
- 2010-2011 R&D Meeting Dates & Deadlines
- 2010-2011 IRB Meeting Dates & Deadlines
Research Protocol Safety Survey
- Research Protocol Safety Survey
- Research Protocol Safety Survey - Instructions
Serious Adverse Event/Adverse Event (SAE/AE)
- SAE/AE Report Form
WOC Application

Research

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