Information Collection

Barriers and Facilitators to HIV Prevention, Care and Treatment among Trasngender Women in Atlanta, Philadelphia and Washington, DC

IC 225125 under ICR 201505-0920-007 · OMB 0920-1091.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1091 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Barriers and Facilitators to HIV Prevention, Care and Treatment among Trasngender Women in Atlanta, Philadelphia and Washington, DC	Form and Instruction
Eligibility Screener Att 3a Eligibility Screener Transg Women.docx	Form and Instruction
Demographic Questionnaire - Transgender Women Att 3b DemoQuestionnaire Trans Women.docx	Form
Demographic Questionnaire - Healthcare Providers Att 3c DemoQuestonnaire Healthcare Providers.docx	Form
INterview Guide HIV- Transgender Women Att 3d Interview Guide HIV Negative Transgender Women.docx	Form
Interview Guide - HIV+ Transgender Women Att 3e Interview Guide HIV Positive TransWomen.docx	Form
Interview Guide Healthcare Providers Att 3f Interview Guide Healthcare Providers.docx	Form
SSA.docx Supporting Statement A	IC Document
SSB.docx Supporting Statement B	IC Document
Att 1 Recruitment Materials.docx Recruitment Materials	IC Document
Att 2 Consent Forms.docx Consent Forms	IC Document
Att 4 Abt IRB 0853 Transgender Full Approval.pdf IRB Approval	IC Document
Attachment 5 CoC Barriers and Facilitators to HIV Prevention, Care, and Treatment amo....pdf Certificate of Confidentiality	IC Document
Tqual Project-Determination-and-Approval-Form _JD_Approval-9-7-16.pdf Research Determination	IC Document

IC Title:

Barriers and Facilitators to HIV Prevention, Care and Treatment among Trasngender Women in Atlanta, Philadelphia and Washington, DC

Agency IC Tracking Number:

17KT

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Eligibility Screener	Att 3a Eligibility Screener Transg Women.docx	No		Paper Only
Form	none	Demographic Questionnaire - Transgender Women	Att 3b DemoQuestionnaire Trans Women.docx	Yes	No	Paper Only
Form	none	Demographic Questionnaire - Healthcare Providers	Att 3c DemoQuestonnaire Healthcare Providers.docx	No		Paper Only
Form	none	INterview Guide HIV- Transgender Women	Att 3d Interview Guide HIV Negative Transgender Women.docx	No		Paper Only
Form	none	Interview Guide - HIV+ Transgender Women	Att 3e Interview Guide HIV Positive TransWomen.docx	No		Paper Only
Form	none	Interview Guide Healthcare Providers	Att 3f Interview Guide Healthcare Providers.docx	No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 180

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	61	61
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	SSA.docx	01/12/2017
Supporting Statement B	SSB.docx	01/12/2017
Recruitment Materials	Att 1 Recruitment Materials.docx	01/12/2017
Consent Forms	Att 2 Consent Forms.docx	01/12/2017
IRB Approval	Att 4 Abt IRB 0853 Transgender Full Approval.pdf	01/12/2017
Certificate of Confidentiality	Attachment 5 CoC Barriers and Facilitators to HIV Prevention, Care, and Treatment amo....pdf	01/12/2017
Research Determination	Tqual Project-Determination-and-Approval-Form _JD_Approval-9-7-16.pdf	01/12/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.