(For Headquarters Use Only) LOI NUMBER
VHA RESEARCH & DEVELOPMENT LETTER OF INTENT COVER PAGE
1. RESEARCH & DEVELOPMENT SERVICE
BIOMEDICAL LABORATORY R&D SERVICE (BLR&D) CLINICAL SCIENCE R&D SERVICE (CSR&D) HEALTH SERVICES R&D SERVICE (HSR&D) REHABILITATION R&D SERVICE (RR&D)
3. PROGRAM AND LEVEL
MERIT REVIEW Standard Merit Review CAREER DEVELOPMENT PROGRAMS Career Development Award 1(CDA-1) Career Development Award 2 (CDA-2) Career Development Transition Award (CDTA) Career Development Enhancement Award (CDEA)
2. IS THIS LOI
NEW REVISION RESUBMISSION (no changes)
RESPONSE TO SPECIFIC ANNOUNCEMENT (provide RFA title and number)
IF REVISION OR RESUBMISSION, INDICATE PREVIOUS LOI NUMBER
OTHER (Specify)
4. PROJECT TITLE (Be succinct and descriptive. May not exceed 72 characters, including spaces.)
5. PRINICIPAL INVESTIGATOR LAST NAME, FIRST NAME DEGREE(S)
MAIL CODE
VA TITLE
GRADE
Current % VA /8ths
Expected % VA /8ths
APPLYING AS A ACADEMIC AFFILIATION
CLINICIAN
NONCLINICIAN
U.S. CITIZEN ACADEMIC RANK
YES
NO
FULL ADDRESS FOR EXPRESS OR COURIER DELIVERY
TELEPHONE FAX E-MAIL
6. ASSOCIATE CHIEF OF STAFF (or Coordinator for R&D) NAME TITLE
MEDICAL CENTER
TELEPHONE
FAX
E-MAIL
SIGNATURE
DATE
VA FORM MAR 2006
10-1313-13
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