Composition of Proposed CoC TRACToo

Attachment 4 Composition of Proposed CoC TRACTool.docx

Co-location and Integration of HIV Prevention and Medical Care into Behavioral Health Program

Composition of Proposed CoC TRACToo

OMB: 0930-0343

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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

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorJacobus-Kantor, Laura (SAMHSA/CBHSQ)
File Modified0000-00-00
File Created2021-01-27

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