Official VA Form

VA Form 10-0455a

Clinical Trial Inclusion/Enrollment Report

VA Form 10-0455a — Clinical Trial Inclusion/Enrollment Report is an official U.S. Department of Veterans Affairs form. The current version was last revised 2008-11-22. It is 1 page long. Download the up-to-date PDF below — BaseNeed syncs form data directly from VA.gov so you always get the current edition.

Download the official PDF (VA.gov) →

Last revised: 2008-11-22
First issued: 2022-03-22
Pages: 1
Administered by: VHA

Frequently asked questions

What is VA Form 10-0455a used for?

Clinical Trial Inclusion/Enrollment Report. It is an official VA form, administered by VHA.

Where can I download the current VA Form 10-0455a?

Download the official PDF from VA.gov here: https://www.va.gov/vaforms/medical/pdf/10-0455A-fill.pdf (last revised 2008-11-22).

How long is VA Form 10-0455a?

VA Form 10-0455a is 1 page long, last revised 2008-11-22.

Always the current version — synced from VA.gov. BaseNeed is not affiliated with the U.S. Department of Veterans Affairs.

You are not the first person to deal with this

BaseNeed is a members-only community for service members, veterans, spouses and their families. Nothing posted inside is public — not on Google, not on Facebook. That is the point: people talk about moves, money and paperwork there, and that only works behind a door.

Nearby form numbers

VA Form 10-0453 — Screening Checklist (Appointee)- fillable

VA Form 10-0454 — Military Treatment Facility Referral to VA Liaison

VA Form 10-0455 — Clinical Trial Annual Progress Report

VA Form 10-0459 — Credentialing Release of Information Authorization

VA Form 10-0460 — Request for Prescription Drugs from an Eligible Veteran in a State Home

VA Form 10-0462 — Political Activities Fact Sheet and Certification