Cover Sheet for Signed 10-0483s (Acknowledgement of NOPP) __________________ ____________________ Date of Delivery to the Research Service: IRB #: _______________________________________________________________________________________________ Protocol Title: ______________________________________________ __________________ Principal Investigator: Phone #: ____________________________________________________ Email: ______________________________________________ __________________ Contact Person: Phone #: ________________________________________________ Email: Participant Complete Last Name + Explanation if the participant: [Research Service Use Only] Last 4 IS a NON-Vet DOES have a CPRS chart, this No Problem (Specify) chart BUT for A 10-0483 is not included in this (10-0483) Y/N Y/N Y/N attached packet CPRS (X) (Confirm) participant is Non-Veteran A NOPP exists 1 2 3 4 5 6 7 8 9
Cover Sheet for Signed 10-0483s (Acknowledgement of NOPP) Date of Delivery to the Research Service: __________________ IRB #: ____________________ Protocol Title: _______________________________________________________________________________________________ Principal Investigator: ______________________________________________ Phone #: __________________ Email: ____________________________________________________ Contact Person: ______________________________________________ Phone #: __________________ Email: ________________________________________________ Participant Complete Last Name + Last 4 Non-Veteran (Confirm) Y/N A CPRS chart exists for this participant Y/N NOPP (10-0483) is attached Y/N Explanation if the participant: IS a NON-Vet DOES have a CPRS chart, BUT A 10-0483 is not included in this packet [Research Service Use Only] No (X) Problem (Specify) 1 2 3 4 5 6 7 8 9
Cover_Sheet_for_Signed_10-0483s.docx