VACS Project Proposal Form.doc

Veterans Aging Cohort Study (VACS)

Project Form

This form is to be used for all project proposals, including internal proposals.

The completed Project Form should be sent electronically to Teresa Bohan (Te)

SECTION I – PROPOSAL

A. Contact Information

Lead Investigator:
Project Title:
Institution:
Address:
Contact Person:
Including address if different
Telephone:
Fax:
Email:
Coinvestigators/Writing Comm:
Collaborating Cohort

B. Submission – Are the results of this analysis intended for:

Abstract submitted to:
Journal article submitted to:
Other:

C. Funding

Is funding available to cover this project?
Who will be performing these analyses?

D. Alcohol Information

Is alcohol a focus of this analysis?
Are alcohol variables include in this analysis?

E. Cohort Selection:

Please mark the cohort you plan to use for this project:

HIV Positive / Controls
VACS 3
VACS 5
VACS
Virtual Cohort

F. Innovativeness

How does this proposal differ from projects already underway?

G. Study Design

Use the following organization to briefly present your study plan. Please respond completely to each section. Use at least 11 point font and limit this section to 2 pages (excluding references).

1. Research question and hypothesis

2. Background including rationale and significance:

3. Data elements requested

4. Study Design & methodology

5. Relevance to VACS study aims

6. References

SECTION II – SPECIFICATION

Requested by:

Modified:

Spec Author:

Programmer/Analyst:

Program Name:

Programming due date:

QA assigned to:

QA due date:

IRB Approval: Is this project already covered by an active IRB approval? If so, list the IRB reference and time period:

A copy of IRB approval should be sent via fax to Teresanne Bohan (203-937-4926). No data sets will be released without IRB approval.

VACS programmer & analyst estimate of workload (to be completed once specification is finalized):

Specific Aims/Overview of Analysis:

Notes:

Population:

Definition of Baseline:

Request #1: Please create a dataset containing the following variables:

Variable Name / Description

Request #2:

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