OMB.report

Federal forms, ICRs, and supporting documents

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.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Eligibility Screener Barriers and Facilitators to HIV Prevention, Care and Treatment among Trasngender Women in Atlanta, Philadelphia and Washington, DC Form and Instruction
Demographic Questionnaire - Transgender Women Barriers and Facilitators to HIV Prevention, Care and Treatment among Trasngender Women in Atlanta, Philadelphia and Washington, DC Form
Demographic Questionnaire - Healthcare Providers Barriers and Facilitators to HIV Prevention, Care and Treatment among Trasngender Women in Atlanta, Philadelphia and Washington, DC Form
INterview Guide HIV- Transgender Women Barriers and Facilitators to HIV Prevention, Care and Treatment among Trasngender Women in Atlanta, Philadelphia and Washington, DC Form
Interview Guide - HIV+ Transgender Women Barriers and Facilitators to HIV Prevention, Care and Treatment among Trasngender Women in Atlanta, Philadelphia and Washington, DC Form
Interview Guide Healthcare Providers Barriers and Facilitators to HIV Prevention, Care and Treatment among Trasngender Women in Atlanta, Philadelphia and Washington, DC Form
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 AIC Document
SSB.docx Supporting Statement BIC 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

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction none No   Paper Only
Form none Yes No Paper Only
Form none No   Paper Only
Form none No   Paper Only
Form none No   Paper Only
Form none No   Paper Only

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 180 0 180 0 0 0
Annual IC Time Burden (Hours) 61 0 61 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
Supporting Statement A 01/12/2017
Supporting Statement B 01/12/2017
Recruitment Materials 01/12/2017
Consent Forms 01/12/2017
IRB Approval 01/12/2017
Certificate of Confidentiality 01/12/2017
Research Determination 01/12/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].