PADRECC Research Consent Form

Research Consent-10-1086-fill.pdf

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

PADRECC Research Consent Form

OMB: 2900-0770

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RESEARCH CONSENT FORM
SUBJECT NAME

DATE (MM/DD/YYYY)

TITLE OF STUDY
PRINCIPLE
INVESTIGATOR

VAMC

DESCRIPTION OF RESEARCH BY INVESTIGATOR 1.Purpose of study and how long it will last: 2. Description of
study including procedures to be use:; 3. description of procedures that may result in disconfort or inconvenience:
4. Expected risks of study: 5. Expected benefits of study: 6. Other treatment available: 7. Use of research results:
8. Special circumstances.

SUBJECT'S IDENTIFICATION

VA FORM
MAR 2006

10-1086

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