OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201809-0920-009 · OMB 0920-1246 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Staff Interview Form Unchanged Available
Participant Interview Form Unchanged Repair queued
Follow-up Assessment Form Modified Available
Baseline Assessment Form Modified Available
Contact Information Form Unchanged Repair queued
Eligibility Screening Form Unchanged Available
SSB_23Aug2018.docx Supporting Statement B Uploaded 2018-09-28 Available
SSA_9Oct2018.docx Supporting Statement A Uploaded 2018-10-31 Available
Att 9_Certificate of Confidentiality.pdf Supplementary Document Uploaded 2018-09-07 Available
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 Available
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 Available
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 Repair queued
Att 3_Recruitment Materials.doc Supplementary Document Uploaded 2018-09-07 Available
Att 2_60-Day FRN.pdf Supplementary Document Uploaded 2018-09-07 Available
Att 1_Auth Legislation.docx Supplementary Document Uploaded 2018-09-07 Available
IC Document Collections
IC IDCollectionTypeStatusForm
232941 Staff Interview Form Unchanged
232939 Participant Interview Form Unchanged
232936 Follow-up Assessment Form Modified
232934 Baseline Assessment Form Modified
232931 Contact Information Form Unchanged
232928 Eligibility Screening Form Unchanged
ICR Details
0920-1246 201809-0920-009
Historical Active 201807-0920-013
HHS/CDC 0920-18CI
Evaluation of TransLife Center (TLC): A Locally-Developed Combination Prevention Intervention for Transgender Women at High Risk of HIV Infection
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 10/31/2018
Retrieve Notice of Action (NOA) 09/28/2018
Approved with the understanding that this is an exploratory study and incentive amounts, although more that typically offered, may be necessary to determine if a more rigorous study is possible.
  Inventory as of this Action Requested Previously Approved
10/31/2021 36 Months From Approved
465 0 0
255 0 0
6,207 0 0
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 Children’s 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.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  83 FR 4207 01/30/2018
83 FR 45451 09/07/2018
Yes
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 465 0 0 465 0 0
Annual Time Burden (Hours) 255 0 0 255 0 0
Annual Cost Burden (Dollars) 6,207 0 0 6,207 0 0
Yes
Miscellaneous Actions
No
This is a new information collection request.
$695,535
Yes Part B of Supporting Statement
    Yes
    Yes
No
No
No
Uncollected
Renita Macaluso 770 488-6458 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/28/2018