Value Analysis Committee (VAC) Request Disclaimer

Please read before proceeding to fill out the form

By clicking on the VAC request form button below, you acknowledge and consent to the following important disclaimers:

• The value analysis request portal has no save feature. Please make sure to have all necessary information and documentation (e.g. FDA HDE letter, IRB approval notice, supporting documents, etc.) prior to starting your submission form.

• Requestors must reattach all files to the form during the second attempt if an error occurred during original submission (e.g. a user forgets to fill in the required "manufacturer" field. The request will not go through and an error message will appear. He/she must attach the "UCLA IRB approved informed consent form" and all other required file attachment fields again during the resubmission.

• The value analysis request portal is intended for UCLA Health only. Users must be connected to the UCLA network (intranet) to access all value analysis request forms.

VAC Request Form