Composition of Proposed CoC TRACToo

	Current OMB Approval Number	Completed by Individuals Receiving Integrated HIV Services	Completed by Individuals Receiving Prevention Services Only
Record Management	OMB 0930-0285	Yes	Yes
Demographics	OMB: 0930-0285	At baseline only	At baseline only
Functioning	OMB: 0930-0285	Yes	No
Functioning – Substance Use Questions	OMB: 0930-0208	Yes	No
Military Family and Dependents	OMB: 0930-0285	Yes	No
Violence and Trauma	OMB: 0930-0285	Yes	No
Stability in Housing	OMB: 0930-0285	Yes	No
Education and Employment	OMB: 0930-0285	Yes	No
Crime and Criminal Justice Status	OMB: 0930-0285	Yes	No
Perception of Care	OMB: 0930-0285	Yes	No
Social Connectedness	OMB: 0930-0285	Yes	No
Program Specific Questions	H1-H14: OMB 0930-0298 H15: OMB 0930-0208;	Yes	Yes
Reassessment	OMB: 0930-0285	Yes, at reassessment	No
Clinical Discharge	OMB: 0930-0285	At discharge	At discharge
Services Received	OMB: 0930-0285	Yes, at reassessments and discharge	Yes, at discharge

Attachment 4

Composition of Proposed CoC TRAC Tool