Information Collection Request

Evaluation of TransLife Center (TLC): A Locally-Developed Combination Prevention Intervention for Transgender Women at High Risk of HIV Infection

ICR 201807-0920-013 · OMB 0920-1246 · Historical Inactive

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-1246 can be found here:

Forms and Documents

Document	Type	Status	Availability
Staff Interview	Form	New	Repair queued
Participant Interview	Form	New	Repair queued
Follow-up Assessment	Form	New	Repair queued
Baseline Assessment	Form	New	Available
Contact Information	Form	New	Available
Eligibility Screening	Form	New	Repair queued
Att 9_Certificate of Confidentiality.pdf	Supplementary Document	Uploaded 2018-09-07	Repair queued
Att 8 PIA 18CI Final.pdf	Supplementary Document	Uploaded 2018-09-07	Available
Att 7_Data Use Plan.doc	Supplementary Document	Uploaded 2018-09-07	Repair queued
Att 6c_UIC IRB Determination.pdf	Supplementary Document	Uploaded 2018-09-07	Repair queued
Att 6b_Chicago House IAA.pdf	Supplementary Document	Uploaded 2018-09-07	Repair queued
Att 6a_Lurie IRB Letter of Approval.pdf	Supplementary Document	Uploaded 2018-09-07	Available
Att 5b_Consent to Interview.pdf	Supplementary Document	Uploaded 2018-09-07	Available
Att 5a_Consent to Intervention.pdf	Supplementary Document	Uploaded 2018-09-07	Available
Att 3_Recruitment Materials.doc	Supplementary Document	Uploaded 2018-09-07	Repair queued
Att 2_60-Day FRN.pdf	Supplementary Document	Uploaded 2018-09-07	Available
Att 1_Auth Legislation.docx	Supplementary Document	Uploaded 2018-09-07	Repair queued
SSB_23Aug2018.docx	Supporting Statement B	Uploaded 2018-09-07	Available
SSA_23Aug2018.docx	Supporting Statement A	Uploaded 2018-09-07	Available

IC Document Collections

IC ID	Collection	Type	Status
232941	Staff Interview	Form	New
232939	Participant Interview	Form	New
232936	Follow-up Assessment	Form	New
232934	Baseline Assessment	Form	New
232931	Contact Information	Form	New
232928	Eligibility Screening	Form	New

ICR Details

OMB Control No: 0920-1246	ICR Reference No: 201807-0920-013
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-18CI
Title: Evaluation of TransLife Center (TLC): A Locally-Developed Combination Prevention Intervention for Transgender Women at High Risk of HIV Infection
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted	Conclusion Date: 09/13/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/07/2018
Terms of Clearance: This ICR has a supporting statement Part B; please resubmit and indicate (radio button selection) that "statistical methods" are used.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		24 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

Abstract: The purpose of this data collection is to evaluate the Translife Center (TLC), which provides combination HIV prevention services to adult transgender women at high risk for HIV infection. Data will be used to compare pre-intervention levels of HIV risk to those at 4 and 8 months post-baseline. Data will be gathered by the cooperative agreement awardee, Chicago House & Social Service Agency, and partner organizations, the Ann & Robert H. Lurie Childrenâs Hospital of Chicago and the University of Illinois at Chicago. Information will be collected through interviewer and self-administered instruments. CDC is requesting a two-year approval.

Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 4207	01/30/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 45451	09/07/2018
Did the Agency receive public comments on this ICR? Yes

Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Follow-up Assessment	n/a	TLC Follow Up Assessment
Participant Interview	n/a	TLC Interview
Eligibility Screening	n/a	TLC Eligibility Screener
Staff Interview	n/a	TLC Interview
Contact Information	n/a	TLC Contact Information
Baseline Assessment	n/a	TLC Baseline Assessment

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new, one-time collection.

Annual Cost to Federal Government: $695,535

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Renita Macaluso 770 488-6458 [email protected]

Common Form ICR: No