Free VA Form 10-1313A - Merit Review Board Summary Sheet - Federal


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Pages: 1
File Format: PDF
State: Federal
Category: Veterans Forms
Word Count: 205 Words, 1,356 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.va.gov/vaforms/medical/pdf/10-1313a.pdf

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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.