Ralph H. JohnsonVA Institutional Animal Care and Use Committee

Annual ACORP Renewal

Charleston, SC

ACORP Title:

Principal Investigator:ACORP Protocol #:Approved Species/Strain:

1.Status of the ACORP :

ACORP to be renewed (Proceed to item 2).

ACORP to be terminated. No further information is required. Sign this form and return it to the ResearchServiceOfficeStromThurmondBuilding room 148.

2.Status of the Animal Component :

Animal Component is unchanged

Animal Component has been modified : Complete the ACORP Amendment Form

(Modifications include changes in species, pain/distress category, surgical procedure, number of animals used, method of euthanasia, and drug and dosages - contact VMO for guidance)

3. Animal research personnel:

Personnel unchanged

Personnel have been added: Complete the ACORP Amendment Form
Personnel have been removed: Name(s) ______

______

4.Annual training: List personnel currently on protocol, list the VA on-line training modules appropriate to this protocol completed by each person (refer to modules by number, see below) and provide date of completion.Confirm that module certificates have been filed with the VA Research Services Office.

Personnel Name / Modules Completed / Date Completed / Certificates Filed
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Modules (Link to On-Line Training:
1 / Working with the Charleston VA IACUC / 9 / Working with Guinea Pigs in Research Settings
2 / Antibody Production Course / 10 / Working with Dogs in Research Settings
3 / Post-Procedure Care of Mice and Rats in Research:Reducing Pain and Distress / 11 / Working with Rats in Research Settings
4 / Working with Mice in Research Settings / 12 / Streaming Videotape- Working Safely with Nonhuman Primates
5 / Working with Cats in Research Settings / 13 / Streaming Videotape (Video CD)- Working with the Laboratory Dog
6 / Working with Gerbils in Research Settings / 14 / Working with the Laboratory Dog CD-ROM: Basic and Advanced Lessons
7 / Working with Hamsters in Research Settings / 15 / Surgery Course
8 / Working with Rabbits in Research Settings / 16 / Essentials for IACUC Members

5.Were there any protocol related unexpected events or a higher mortality rate than anticipated in the past year?

Yes No

If yes, explain. How many animals were affected? ______

I am aware that all research projects using animals must receive prior approval by the IACUC, that any change in animal use requires prior approval by the IACUC, that continuation of approval requires annual review, that animal use in projects not reviewed and approved must be discontinued, and that a copy of all animal related matters must be retained by the Principal Investigator for three (3) years after the study has terminated. This form, together with any requested additional information, is submitted in compliance with these regulations.

______

SIGNATURES:

PI’s SignatureDate

IACUC USE ONLY

Re-Approval Date: ______

______

Chair, IACUCDateVeterinary Medical OfficerDate

Ralph H. Johnson VA IACUC - Annual ACORP Renewal 042607 v3