Free VA Form 10-1313-13 - VHA Research & Development Letter of Intent Cover Page - fillable - Federal


File Size: 299.2 kB
Pages: 1
Date: August 11, 2006
File Format: PDF
State: Federal
Category: Veterans Forms
Word Count: 187 Words, 1,274 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.va.gov/vaforms/medical/pdf/vha-10-1313-13-fill.pdf

Download VA Form 10-1313-13 - VHA Research & Development Letter of Intent Cover Page - fillable ( 299.2 kB)


Preview VA Form 10-1313-13 - VHA Research & Development Letter of Intent Cover Page - fillable
(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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