MERIT REVIEW BOARD SUMMARY STATEMENT
1. TAB NO. 2. APPLICATION NO. 3. REVIEW GROUP 4. REVIEW DATE 5. FACILITY NO.
6. LOCATION HEALTH CARE FACILITY (VAMC, OPC, CITY, STATE)
7. SOCIAL SECURITY NO.
8. DATE OF LAST SUBMISSION MERIT REVIEW
9. PRINCIPAL INVESTIGATOR(S) (Last Name, First Name, M.l.)
DEGREE(S)
TELEPHONE NO.
10. PROGRAM TITLE (72 CHARACTERS MAXIMUM)
11. AMOUNT REINVESTED EACH YEAR
1ST
12. VA EMPLOYMENT STATUS FULL TIME
2ND
3RD
13. VA SALARY SOURCE
4TH
RESEARCH CC103
5TH
PATIENT CARE NEW
TOTAL
14. TYPE PROGRAM
PART TIME
/8 TIME)
RESEARCH CC104
HSR&D
ONGOING
CONSULTING
HRS./WEEK
RESEARCH CC105
RR&D
SUPPLEMENT
ATTENDING
HRS./WEEK
RESEARCH CC110
OTHER VA
NO, PROJECTS IN PROGRAM
WOC 15. PROGRAM
HRS./WEEK
CAREER DEVELOPMENT COST CENTER
16. PRIMARY RESEARCH PROGRAM AREA
PRIMARY SPECIALTY AREA
17. VA HOSPITAL SERVICE AND SECTION
18. ACADEMIC RANK, DEPARTMENT AND AFFILIATION
RECOMMENDATION
PRIORITY SCORE
DURATION
RENEWAL DATE
FUNDING START DATE
DO NOT WRITE IN THESE SPACES
FUNDS NOT SUBJECT TO PRIORITY REDUCTION
YEAR EQUIPMENT PI SALARY
FUNDS SUBJECT TO PRIORITY REDUCTION
TOTAL FUNDING RECOMMENDED BY MERIT REVIEW
TOTAL FUNDING AFTER PRIORITY REDUCTION
1ST 2ND 3RD 4TH 5TH
PROGRAM REVIEW STAFF COMMENTS
VA FORM JAN 1990
10-1313A
EXISTING STOCK OF VA FORM 10-1313A, AUG 1984, WILL BE USED.