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  • Va 10-9012 1989

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Plate or give name - last first middle 21. APPROVED BY A. SUBCOMMITTEE ON HUMAN STUDIES B. RESEARCH AND DEVELOPMENT COMMITTEE VA FORM NOV 1989 10-9012 SUPERSEDES EXISTING STOCK OF VA FORM 10-9012 AUG 1982 WILL BE USED. INVESTIGATIONAL DRUG INFORMATION RECORD 1. TITLE OF STUDY 6. SOURCE OF DRUG If other than manufacturer or sponsor 2. RESPONSIBLE INVESTIGATOR Individual who signed Form FD-1573 7. THERAPEUTIC CLASSIFICATION AND EXPECTED THERAPEUTIC EFFECT S 3. PRINCIPAL INVESTIGATOR If different than responsible investigator 4. ALL DESIGNATIONS FOR DRUG Generic and chemical code trade-names other designations 8. DOSAGE FORMS AND STRENGTHS 9A. IS THIS DRUG A CONTROLLED SUBSTANCE NO If Yes complete Item 9B YES 5. MANUFACTURER OR OTHER SPONSOR 9B. CLASSIFICATION 10. STABILITY AND STORAGE REQUIREMENTS A. PRIOR TO MIXING STORAGE SHOULD BE Check applicable box es AT ROOM TEMPERATURE IN REFRIGERATOR IN FREEZER PROTECTED FROM LIGHT OTHER Specify B. AFTER MIXING DRUG REMAINS STABLE IN REFRIGERATO....

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Investigational drug Related content

VA Form 10-9012 - Veterans Affairs
This site provides public access to all VA forms that are appropriate to be on the web.
Learn more
INVESTIGATIONAL DRUG INFORMATION RECORD
SIGNATURE OF CHAIRPERSON. 10-9012. VA FORM. NOV 1989. I.V.PUSH. NO. SUPERSEDES EXISTING...
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What Is VA Form 21-10210? A sworn declaration form is a statement or letter that a layperson writes to support a Veteran's claim. Usually, this person is without medical expertise, and they can be a family member, friend, or even fellow service member.

Use VA Form 21-0781a if you've been diagnosed with PTSD related to or because of personal assault, and you want to apply for related benefits or services.

What Is VA Form 21-10210? A sworn declaration form is a statement or letter that a layperson writes to support a Veteran's claim. Usually, this person is without medical expertise, and they can be a family member, friend, or even fellow service member.

VA Form 21-10210 is used to provide information about an in-service injury or to give an update on the current severity of their service-connected conditions. However, VA form 21-4138 is no longer in use and the VA Form 21-10210 has been updated to replace it.

VA Form 21-10210: Lay/Witness Statement A VA sworn declaration is a letter or statement in support of a veteran's claim. Sworn declarations are usually written by a layperson or someone without medical expertise. A layperson generally can be a relative, spouse, friend, co-worker, or fellow servicemember.

VA Form 21-10210 is used to provide information about an in-service injury or to give an update on the current severity of their service-connected conditions. However, VA form 21-4138 is no longer in use and the VA Form 21-10210 has been updated to replace it.

Use VA Form 21-4138 when you want to submit a VA “buddy statement” or other statement from someone with firsthand knowledge of information you believe will help support your request for VA benefits.

If you would like to submit an additional statement on your own behalf or if you have more than one witness writing on your behalf, use a separate form (VA Form 21-10210) for each statement.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232