Va Form 10-1313-13 - Vha Research & Development Letter Of Intent Cover Page

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(For Headquarters Use Only)
LOI NUMBER
VHA RESEARCH & DEVELOPMENT LETTER OF INTENT COVER PAGE
1. RESEARCH & DEVELOPMENT SERVICE
3. PROGRAM AND LEVEL
MERIT REVIEW
BIOMEDICAL LABORATORY R&D SERVICE (BLR&D)
Standard Merit Review
CLINICAL SCIENCE R&D SERVICE (CSR&D)
CAREER DEVELOPMENT PROGRAMS
HEALTH SERVICES R&D SERVICE (HSR&D)
Career Development Award 1(CDA-1)
Career Development Award 2 (CDA-2)
REHABILITATION R&D SERVICE (RR&D)
Career Development Transition Award (CDTA)
2. IS THIS LOI
Career Development Enhancement Award (CDEA)
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 81 characters, including spaces.)
5. PRINCIPAL INVESTIGATOR
LAST NAME, FIRST NAME
DEGREE(S)
MAIL CODE
VA TITLE
GRADE
Current % VA
Expected % VA
/8ths
/8ths
U.S. CITIZEN
APPLYING AS A
CLINICIAN
NONCLINICIAN
YES
NO
ACADEMIC AFFILIATION
ACADEMIC RANK
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
10-1313-13
VA FORM
Page 1 of 1
MAR 2006

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