Fillable Printable VA Form 10-1313-13

VA Form 10-1313-13

U.S. CITIZEN

1. RESEARCH & DEVELOPMENT SERVICE

Current % VA

/8ths /8ths

VHA RESEARCH & DEVELOPMENT LETTER OF INTENT COVER PAGE

5. PRINCIPAL INVESTIGATOR

LAST NAME, FIRST NAME

MAIL CODE

ACADEMIC AFFILIATION

FULL ADDRESS FOR EXPRESS OR COURIER DELIVERY

TELEPHONE

NAME

MEDICAL CENTER

TITLE

FAX

TELEPHONE

SIGNATURE

FAX

E-MAIL

DATE

ACADEMIC RANK

VA TITLE GRADE

DEGREE(S)

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)

2. IS THIS LOI

INDICATE PREVIOUS eRA APPLICATON NUMBER, IF

APPLICABLE

4. PROJECT TITLE (Be succinct and descriptive. May not exceed 200 characters, including spaces.)

NEW

RESUBMISSION (no changes from previous LOI)

3. PROGRAM AND LEVEL

Standard Merit Review

Pilot/SPIRE

Career Development Award 1 (CDA-1)

Career Development Award 2 (CDA-2)

Career Development Enhancement Award (CDEA)

Research Career Scientist

Senior Research Career Scientist

RESPONSE TO SPECIFIC ANNOUNCEMENT

(provide RFA title and number)

Expected % VA

6. ASSOCIATE CHIEF OF STAFF (or Coordinator for R&D)

APPLYING AS A CLINICIAN NONCLINICIAN NOYES

MERIT REVIEW

CAREER DEVELOPMENT PROGRAMS

RESEARCH CAREER SCIENTIST

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10-1313-13

VA FORM

MAR 2017

REVISION (changed from previous LOI)