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SAMPLE STATEMENT (to be provided by Reference Laboratory) RE: VA Principal Investigator name, VA Protocol No., Title Chair, Research and Development Committee Miami VA Medical Center 1201 N.W. 16th Street Miami, FL 33125 Biological samples received for protocol number ___________ (sponsor protocol number _____________ [sample: DAC-1001]) will be processed exactly in the manner described in the protocol version approved by the Human Studies Subcommittee and the Research and Development Committee. [option 1:] Documentation of the destruction of any unused sample materials remaining after processing will be provided to the Research and Development Committee. [option 2:] “After processing any unused sample materials will be returned to Dr. _______________ (Investigator name mentioned above).” No part, subset, or portion of these samples will be stored or used in any manner not described in the approved protocol. If you have any questions, please contact ___________________________________________ at the following number (phone number).