Fillable Printable VA Form 10-1313A
Fillable Printable VA Form 10-1313A
VA Form 10-1313A
MERIT REVIEW BOARD SUMMARY STATEMENT
5. FACILITY NO.
4. REVIEW DATE
2. APPLICATION NO.
3. REVIEW GROUP1. TAB NO.
CONSULTING
8. DATE OF LAST SUBMISSION
MERIT REVIEW
6. LOCATION HEALTH CARE FACILITY (VAMC, OPC, CITY, STATE)
7. SOCIAL SECURITY NO.
TELEPHONE NO.
DEGREE(S)
9. PRINCIPAL INVESTIGATOR(S) (Last Name, First Name, M.l.)
10. PROGRAM TITLE (72 CHARACTERS MAXIMUM)
11. AMOUNT REINVESTED EACH YEAR
2ND
TOTAL4TH
1ST
3RD
5TH
14. TYPE PROGRAM
13. VA SALARY SOURCE
12. VA EMPLOYMENT STATUS
NEW
PATIENT CARE
RESEARCH CC103
FULL TIME
ONGOING
PART TIME /8 TIME)
HSR&D
RESEARCH CC104
RR&D SUPPLEMENT
HRS./WEEK
RESEARCH CC105
RESEARCH CC110 NO, PROJECTS IN PROGRAM
ATTENDING
HRS./WEEK
OTHER VA
WOC
CAREER DEVELOPMENTHRS./WEEK
COST CENTER
15. PROGRAM
PRIMARY SPECIALTY AREA
16. PRIMARY RESEARCH PROGRAM AREA
17. VA HOSPITAL SERVICE AND SECTION
18. ACADEMIC RANK, DEPARTMENT AND AFFILIATION
DURATION
FUNDING START DATE
RENEWAL DATERECOMMENDATION
PRIORITY SCORE
TOTAL FUNDING
RECOMMENDED BY
MERIT REVIEW
TOTAL FUNDING
AFTER PRIORITY
REDUCTION
FUNDS SUBJECT
TO PRIORITY
REDUCTION
FUNDS NOT SUBJECT TO PRIORITY REDUCTION
YEAR
EQUIPMENT
PI SALARY
1ST
2ND
3RD
4TH
5TH
PROGRAM REVIEW STAFF COMMENTS
EXISTING STOCK OF VA FORM 10-1313A, AUG 1984, WILL BE USED.
DO NOT WRITE IN THESE SPACES
10-1313A
VA FORM
JAN 1990
