VA Form 10-1086: Research Consent Form

VA Form 10-1086 is the U.S. Department of Veterans Affairs Research Consent Form. VA's form page lists it under VHA, the Veterans Health Administration. The one-page PDF names a research subject, the title of a study, the investigator and the VA medical center (VAMC), with a date in MM/DD/YYYY format.

Its largest box is the description of research by the investigator. The form lists eight points for it: the purpose of the study and how long it will last, a description of the study and its procedures, procedures that may cause discomfort or inconvenience, expected risks, expected benefits, other treatment available, use of research results and special circumstances. A last box holds the subject's identification.

The PDF prints no instructions, filing address or OMB number. You can fill out the PDF free in your browser on this page and download the result without an account.

Top of page 1 of VA Form 10-1086: Research Consent Form, as printed by VA

What's on VA Form 10-1086

Date and subject name

The date in MM/DD/YYYY format and the name of the research subject.

Study, investigator and VAMC

The title of the study, the investigator's name and the VA medical center.

Purpose, procedures and discomfort

Points 1 to 3 of the research description: the purpose of the study and how long it will last, a description of the study and its procedures, and procedures that may cause discomfort or inconvenience.

Risks, benefits and other points

Points 4 to 8: expected risks, expected benefits, other treatment available, use of research results and special circumstances.

Subject's identification

A box at the bottom of the page for the subject's identification. The PDF shows no signature line.

How to fill in VA Form 10-1086

1
Enter the date and subject
Type the date as MM/DD/YYYY and the subject's name.
2
Name the study and investigator
Add the title of the study, the investigator's name and the VAMC.
3
Write the research description
Cover the eight points the form lists, from the purpose and length of the study to special circumstances.
4
Fill in the subject's identification
Complete the last box on the page, then download the filled PDF.

The PDF has no instruction page. These steps follow the order of its boxes.

Why fill Form 10-1086 on indox

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Where it goes

No printed instructions

The one-page PDF prints no instructions, filing address, help line or OMB number. VA's form page lists no online tool.

Edition

The PDF footer reads VA FORM MAR 2006 and Page 1 of 1. VA's form page gives a form revision date of March 2006.

Who uses VA Form 10-1086?

The investigator
The form labels the description box "DESCRIPTION OF RESEARCH BY INVESTIGATOR" and has a box for the investigator's name, printed as PRINCIPLE INVESTIGATOR.
The research subject
The form names the subject at the top and ends with a box for the subject's identification.
The VA medical center
A box labeled VAMC, for the VA medical center, sits next to the investigator's name.
Veterans Health Administration
VA's form page lists the form as related to VHA. The page gives no further detail on who completes or keeps it.

The form prints no instructions. Its box labels show whose details it holds and who writes the research description.

Official sources and the blank

Official VA form page
The agency’s own page for Form 10-1086.
Blank PDF
The official blank form, to print or fill by hand.

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Questions about Form 10-1086

What is VA Form 10-1086?

It is the VA Research Consent Form. It names a research subject, a study, the investigator and the VAMC, and holds the investigator's description of the research.

What does the research description cover?

The form lists eight points: purpose and length of the study, the study and its procedures, procedures that may cause discomfort or inconvenience, expected risks, expected benefits, other treatment available, use of research results and special circumstances.

Who writes the description of research?

The form labels the box "DESCRIPTION OF RESEARCH BY INVESTIGATOR".

Does VA Form 10-1086 have a signature line?

The PDF shows no signature line. Its last box is the subject's identification.

How many pages is VA Form 10-1086?

One. The footer reads Page 1 of 1.

VA Form 10-1086: Research Consent Form