Baseline Assessment

Evaluation of TransLife Center (TLC): A Locally-Developed Combination Prevention Intervention for Transgender Women at High Risk of HIV Infection

OMB: 0920-1246

IC ID: 232934

Documents and Forms
Information Collection (IC) Details

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Baseline Assessment
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form n/a TLC Baseline Assessment Att 4c_TLC Baseline Assessment_23Aug2018.docx Yes Yes Fillable Fileable
Other-Example Screen Shots of a Completed Baseline Assessment TLC Baseline Assessment Screen Shot.pdf Yes Yes Fillable Fileable

Health Illness Prevention

09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems HHS/CDC  57 FR 62812

75 0
   
Individuals or Households
 
   100 %

  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 75 0 75 0 0 0
Annual IC Time Burden (Hours) 75 0 75 0 0 0
Annual IC Cost Burden (Dollars) 1,826 0 1,826 0 0 0

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