VA Providence Healthcare System
Forms for Each Type of Protocol Submission
Described below are the documents required for IACUC/R&D protocol submissions.
V 1/2/2013
Required Forms for New Proposal Submission - All Studies:
- Request to Review Research Proposal/Project Form
- Animal Component of Research Protocol (ACORP), Version 3
- 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, Antibody 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 7, Request to Use Patient Care Procedural Areas for Animal Studies
- ACORP Appendix 8, Request to Use Explosive Agent in the Animal Facility or in Animals
- Scope of Work for Animal-Lab Personnel
- Chief of Service Statement
- BioSafety Form
- RDIS Page 18 for new investigators and Page 18 Codes
- Conflict of Interest Disclosure Form
- CV for New PI and Resume of New Research Staff
- Full Protocol
- Budget
- If the research occurs at another facility, Institutional Safety Committee (or equivalent) approval or exemption for the project.
__________________________________________ __________________________________
PI Signature (only) Date
Continuing Reviews (conducted annually)
Lapsed Protocol Reinstatement Request
If your protocol expires past the IACUC approval period, the protocol is considered lapsed and automatically falls into a suspended category. No activity can occur with the study in this category.
Amendment
- Cover memo detailing amendment (specific item (e.g., protocol).
- Modified materials (e.g., pertinent training documentation, protocol).
Responses to Conditionally Approved Items
- Cover memo from PI detailing responses to conditions.
- Copy of memo issued from the Chairperson (either Committee).
- Modified materials (e.g., pertinent training documentation, protocol, etc).
Responses to Tabled/Disapproved Items
- Cover memo from PI detailing responses to the requests/conditions.
- Copy of memo issued from the Chairperson (either Committee).
- Modified materials (e.g., pertinent training documentation, protocol, etc.).
Study Closure
_________________________________________________ ___________________________
PI Signature (only) Date