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 202010-0920-005 · OMB 0920-1246 · Active

Forms and Documents
DocumentTypeStatusAvailability
Staff Interview Form Unchanged Available
Participant Interview Form Unchanged Available
Follow-up Assessment Form Modified Available
Baseline Assessment Form Modified Repair queued
Contact Information Form Unchanged Available
Eligibility Screening Form Modified Repair queued
Summary of Proposed Changes in the ICR for TLC 0920-1246.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-10-15 Available
CDC-Research-Protocol_Form Approved09-21-20_clean.docx Supplementary Document Uploaded 2020-10-15 Repair queued
SSB_08Oct20_clean.docx Supporting Statement B Uploaded 2020-10-15 Available
SSA_08Oct20_clean.docx Supporting Statement A Uploaded 2020-10-15 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
TG Data Use Plan3Apr2017.docx Supplementary Document Uploaded 2020-10-15 Repair queued
Att 6c_UIC IRB Determination.pdf Supplementary Document Uploaded 2018-09-07 Available
2017-767_Initial IRB approval.pdf Supplementary Document Uploaded 2020-10-15 Available
2017-767_Mod Approval Letter.pdf Supplementary Document Uploaded 2020-10-15 Available
Att 5b_Consent to Interview.pdf Supplementary Document Uploaded 2018-09-07 Available
Appendix D_Adult-consent-COVID_ v10-05-20_clean.docx Supplementary Document Uploaded 2020-10-15 Available
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 Modified
ICR Details
0920-1246 202010-0920-005
Active 201809-0920-009
HHS/CDC 0920-1246-21AK
Evaluation of TransLife Center (TLC): A Locally-Developed Combination Prevention Intervention for Transgender Women at High Risk of HIV Infection
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 11/18/2020
Retrieve Notice of Action (NOA) 10/15/2020
Previous terms continue: 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 10/31/2021 10/31/2021
465 0 465
255 0 255
6,207 0 6,207
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. This change request is due to COVID-19 and changes some collections from in-person to online or phone.
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 465 465 0 0 0 0
Annual Time Burden (Hours) 255 255 0 0 0 0
Annual Cost Burden (Dollars) 6,207 6,207 0 0 0 0
No
No
This is a new information collection request.
$695,535
Yes Part B of Supporting Statement
    Yes
    Yes
No
No
No
No
Kevin Joyce 404 639-1944 [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.
10/15/2020