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

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VHA RESEARCH & DEVELOPMENT LETTER OF INTENT COVER PAGE
1. RESEARCH & DEVELOPMENT SERVICE/PROGRAM
3. PROGRAM AND LEVEL
BIOMEDICAL LABORATORY R&D SERVICE (BLR&D)
MERIT REVIEW
RESEARCH CAREER SCIENTIST
CLINICAL SCIENCE R&D SERVICE (CSR&D)
Standard Merit Review
Research Career Scientist
COOPERATIVE STUDIES PROGRAM (CSP)
Pilot/SPIRE
Senior Research Career Scientist
HEALTH SERVICES R&D SERVICE (HSR&D)
REHABILITATION R&D SERVICE (RR&D)
CAREER DEVELOPMENT PROGRAMS
OTHER
Career Development Award 1 (CDA-1)
2. IS THIS LOI
Career Development Award 2 (CDA-2)
NEW
REVISION (changed from previous LOI)
Career Development Enhancement Award (CDEA)
RESUBMISSION (no changes from previous LOI)
INDICATE PREVIOUS eRA APPLICATON NUMBER, IF
RESPONSE TO SPECIFIC ANNOUNCEMENT
APPLICABLE
(provide RFA title and number)
4. PROJECT TITLE (Be succinct and descriptive. May not exceed 200 characters, including spaces.)
5. PRINCIPAL INVESTIGATOR
LAST NAME, FIRST NAME
DEGREE(S)
MAIL CODE
VA TITLE
GRADE
Current % VA
Expected % VA
/8ths
/8ths
APPLYING AS A
CLINICIAN
NONCLINICIAN
U.S. CITIZEN
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
VA FORM
10-1313-13
Page 1 of 1
MAR 2017

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