Va Form 10-1436 -

ADVERTISEMENT

CONTROL NUMBER
RESEARCH AND DEVELOPMENT INFORMATION SYSTEM
(Leave blank)
PROJECT DATA SHEET
2. LOCATION (City, State)
1. HEALTH CARE
3. PRINCIPAL INVESTIGATOR (Last, First, M.I., Degree)
4. SOCIAL SECURITY NO.
FACILITY NO.
5. STATUS IN PROJECT
6. PROJECT NUMBER
7. TYPE OF REPORT
01 AWARDEE (Recipient of Award)
INITIAL
PROGRES
FINAL
02 NOT AWARDEE, BUT RESPONSIBLE VA
INVESTIGATOR
8. PROJECT TlTLE (Do Not Exceed 142 Spaces)
9. HAS PROJECT TITLE CHANGED SINCE LAST REPORT?
YES
NO
10. CO-PRINCIPAL INVESTIGATOR(S) NAME, DEGREE(S) AND SOCIAL SECURITY NO. (Maximum of 2)
_ _ _ _ - _ _ - _ _ _ _ _ _
_ _ _ _ - _ _ - _ _ _ _ _ _
1.
2.
11. FUNDING AND ADMINISTRATION (See codes on instruction sheets)
ADMIN. CODE
FUNDING CODE
NAME IF "OTHER"
1.
2.
3.
12. PROJECT USES (Each item must have a response)
YES
RADIOISOTOPES
HUMAN SUBJECTS
YES
NO
INVESTIGATIONAL
NO
YES
NO
ANIMAL SUBJECTS
YES
NO
YES
NO
NO
INVESTIGATIONAL DEVICES
BIOHAZARDS
YE
13. RESEARCH FOCUS: (Mark yes only if the major reason for the research project is to study the particular topic)
YES
NO
AGENT ORANGE (DIOXIN)
FEMALES
YES
NO
YES
PRISONERS OF WAR
NO
14. KEYWORDS (MeSH terms only; minimum three, specify up to eight)
1.
5.
2.
6.
3.
7.
8.
4.
15. ABSTRACT (Enter on reverse)
16. SIGNATURE OF PRINCIPAL INVESTIGATOR
17. DATE
VA FORM
10-1436
EXISTING STOCKS OF VA FORM 10-1436, MAY 1985,
PAGE 1
JUN 1989
WILL NOT BE USED

ADVERTISEMENT

00 votes

Related Articles

5 Things You Need To Know About The Gi Bill Benefits
Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids

Related forms

Va Form 10-0094h - Education Affiliation Agreement Between The Department Of Veterans Affairs (va) And A Non-va Health Care Facility Or Agency Va Form 10-0094h - Education Affiliation Agreement Between The Department Of Veterans Affairs (va) And A Non-va Health Care Facility Or Agency Legal
Va Form 10-0454 - Military Treatment Facility Referral Form To Va Liaison Va Form 10-0454 - Military Treatment Facility Referral Form To Va Liaison Legal
Va Form 10-0094d - Dental Education Affiliation Agreement Between Department Of Veterans Affairs (va) And A School Of Dentistry As The Sponsoring Institution - 2015 Va Form 10-0094d - Dental Education Affiliation Agreement Between Department Of Veterans Affairs (va) And A School Of Dentistry As The Sponsoring Institution - 2015 Legal
Va Form 10-0094a - Medical Education Affiliation Agreement Between Department Of Veterans Affairs (va), And Institutions Sponsoring Graduate Medical Education And Their Affiliated School Of Medicine Va Form 10-0094a - Medical Education Affiliation Agreement Between Department Of Veterans Affairs (va), And Institutions Sponsoring Graduate Medical Education And Their Affiliated School Of Medicine Legal
Va Form 10-8001 - Refusal Of Transfer To Va Health Care Facility Va Form 10-8001 - Refusal Of Transfer To Va Health Care Facility Legal
Va Form 10-0094b - Medical Education Affiliation Agreement Between Department Of Veterans Affairs (va), And A School Of Osteopathic Medicine Va Form 10-0094b - Medical Education Affiliation Agreement Between Department Of Veterans Affairs (va), And A School Of Osteopathic Medicine Legal
Va Form 10-0094f -dental Education Affiliation Agreement Between Department Of Veterans Affairs (va) And Institutions Sponsoring Dental Education Va Form 10-0094f -dental Education Affiliation Agreement Between Department Of Veterans Affairs (va) And Institutions Sponsoring Dental Education Legal
Va Form 10-0094a - Medical Education Affiliation Agreement Between Department Of Veterans Affairs (va), And A School Of Medicine And Its Affiliated Participating Institutions Va Form 10-0094a - Medical Education Affiliation Agreement Between Department Of Veterans Affairs (va), And A School Of Medicine And Its Affiliated Participating Institutions Legal
Va Form 10-0415 - Va Geriatrics And Extended Care (gec) Referral Va Form 10-0415 - Va Geriatrics And Extended Care (gec) Referral Legal
Va Form 10-0094c - Medical Education Affiliation Agreement Between Department Of Veterans Affairs (va) And Institutions Sponsoring Graduate Medical Education Va Form 10-0094c - Medical Education Affiliation Agreement Between Department Of Veterans Affairs (va) And Institutions Sponsoring Graduate Medical Education Legal

Related Categories

Parent category: Legal
Download
Go
Page of 4