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VA Central IRB Forms: Investigator Forms

These are investigator-initiated forms and are grouped according to type of action being requested or reported.


« back to all VA Central IRB forms

New Study Application Forms
Form #TitleRevision Date
102Local ACOS / R&D Review Supplement (117KB, MSWord)January 18, 2019
103Request for Waiver or Alteration of HIPAA Authorization (587KB, MSWord)January 21, 2019
104Local Site Investigator Application (805KB, MSWord)February 12, 2019
104aCo-Local Site Investigator New Project Application Supplement (544KB, MSWord)May 13, 2019
104 - NSILocal Site Investigator Application – No Subject Interactions (648KB, MSWord)February 12, 2019
105Request for Exemption of Research (623KB, MSWord)February 5, 2019
108Principal Investigator/Study Chair New Project Application (701KB, MSWord)April 10, 2019
108Principal Investigator/Study Chair New Project Application — No Subject Interactions (486KB, MSWord)January 16, 2019
108aCo-Principal Investigator/Study Chair New Project Application Supplement
(560KB, MSWord)
January 18, 2019
108a - DOECo-Principal Investigator/Study Chair New Project Application Supplement - DOE
(570KB, MSWord)
January 18, 2019
108bCoordinating Center PI/SC New Project Application Supplement (553KB, MSWord)January 18, 2019
110aVulnerable Population Supplement (Pregnant Women) (555KB, MSWord)January 18, 2019
110bVulnerable Population Supplement (Prisoners) (558KB, MSWord)January 18, 2019
112aRequest for Waiver or Alteration of the Informed Consent Process (580KB, MSWord)January 15, 2019
112bRequest for Waiver of Documentation of Informed Consent (564KB, MSWord)January 15, 2019
n/aCombined Informed Consent/HIPAA Authorization Template (235KB, MSWord)January 18, 2019
n/aInformed Consent Template Only (249KB, MSWord)January 18, 2019
118Request for Determining Whether an Activity/Project is Research and/or Human Subjects Research (608KB, MSWord)July 1, 2010
n/aInformation Sheet Template (Waiver of Documentation of Informed Consent)
(124KB, MSWord)
January 21, 2019
n/aProtocol Template (58KB, MSWord)January 21, 2019
n/aDeception in Research Guidelines (93KB, MSWord)January 21, 2019
Amendments, Protocol Exceptions, and Continuing Review
Form #TitleRevision Date
115aApplication for Continuing Review — Principal Investigator/Study Chair (390KB, MSWord)January 7, 2019
115bApplication for Continuing Review — Local Site Investigator
(1.6MB, MSWord)
September 18, 2017
116Request to Amend or Modify an Approved Project (601KB, MSWord)December 10, 2018
117aProject Closure Report (225KB, MSWord)May 16, 2017
117bLocal Site Project Participation Closure Report (594KB, MSWord)August 7, 2017
127Request for an Exception to an Approved Protocol (127KB, MSWord)December 26, 2018
134aChange in Principal Investigator/Study Chair (564KB, MSWord)January 15, 2019
134bChange in Local Site Investigator (1.5MB, MSWord)January 15, 2019
Reporting Requirements
Form #TitleRevision Date
119Report of Serious Adverse Events and Unanticipated Problems Involving Risks to Participants or Others (627KB, MSWord)October 14, 2015
129Report of Protocol Deviations or Violations (154KB, MSWord)March 20, 2014

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