ACORP AMENDMENT RALPH H. JOHNSON DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC) IACUC Chair Date Veterinary Medical Officer Date AREA Designated Approval Date: Significant Change with AV Verification IACUC ACORP Investigator: Number: ACORP Title: Species / Strain(s) (with Stock Number, if Applicable): Are new personnel to be added to the protocol? Yes No List new personnel and provide qualifications for procedures for which they are to be responsible. Study Personnel: Animal Research Experience: Procedure (add lines, if needed) Experience with each Procedure in Relevant ACORP Species To be Trained Are additional animals requested, or are animals to be replaced (same or different strain)? Yes No Provide animal numbers in the table below, describe the requested change and justify the total numbers of animals requested. A power analysis is strongly encouraged. Source Species Age / Size Health (add Stock #, if Gender (add Special Features, if Applicable) on Receipt Status Applicable) Total Approved Allocation Increase Replace Number of Animals Percent Increase Procedure Status Location of Preapproved Proposed Procedure(s) for Animals Procedure Details (e.g., ACORP New Preapproved C.2.c, App. 6, amendment [date]) complete item 4 Is the use of new test substances, anesthetics, or analgesics to be added? Yes No Please describe the reason for adding the new compound. Attach the current revision of ACORP Appendix 3 with highlighted changes and a material safety data sheet. For each material identified as Toxic, Infectious, Biological, Radioactive, or Agents Containing Recombinant Nucleic Acid (Appendix 3 items 4 8), please attach a SOP for use. –
ACORP AMENDMENT RALPH H. JOHNSON DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC) IACUC AREA IACUC Chair Date Veterinary Medical Officer Date Designated Approval Date: Significant Change with AV Verification Investigator: ACORP Number: ACORP Title: Species / Strain(s) (with Stock Number, if Applicable): Are new personnel to be added to the protocol? Yes No List new personnel and provide qualifications for procedures for which they are to be responsible. Study Personnel: Animal Research Experience: Procedure (add lines, if needed) Experience with each Procedure in Relevant ACORP Species To be Trained Are additional animals requested, or are animals to be replaced (same or different strain)? Yes No Provide animal numbers in the table below, describe the requested change and justify the total numbers of animals requested. A power analysis is strongly encouraged. Species (add Special Features, if Applicable) Gender Age / Size on Receipt Source (add Stock #, if Applicable) Health Status Total Approved Allocation Increase Replace Number of Animals Percent Increase Proposed Procedure(s) for Animals Procedure Status Location of Preapproved Procedure Details (e.g., ACORP C.2.c, App. 6, amendment [date]) New Preapproved complete item 4 Is the use of new test substances, anesthetics, or analgesics to be added? Yes No Please describe the reason for adding the new compound. Attach the current revision of ACORP Appendix 3 with highlighted changes and a material safety data sheet. For each material identified as Toxic, Infectious, Biological, Radioactive, or Agents Containing Recombinant Nucleic Acid (Appendix 3 items 4 – 8), please attach a SOP for use.
ACORP%20Amendment.docx