Transgender Women > 18 years old - Eligibility Screener

Barriers and Facilitators to Expanding the NHBS to Conduct HIV Behavioral Surveillance Among Transgender Women (NHBS-Trans)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1262 can be found here:

Documents and Forms

Document Name Document Type
18 years old - Eligibility Screener Form and Instruction
Eligibility Screener (English) Att 4a_Eligibility Screener (English).docx Form and Instruction
Eligibility Screener (English) Att 4a_Eligibility Screener (English).docx Form and Instruction
Eligibility Screener (Spanish) Att 5a_Eligibility Screener (Spanish).docx Form and Instruction
Eligibility Screener (Spanish) Att 5a_Eligibility Screener (Spanish).docx Form and Instruction

Information Collection (IC) Details

IC Title:	Transgender Women > 18 years old - Eligibility Screener	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Eligibility Screener (English)	Att 4a_Eligibility Screener (English).docx		Yes	Yes	Fillable Fileable
Form and Instruction	None	Eligibility Screener (Spanish)	Att 5a_Eligibility Screener (Spanish).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0136 Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 76 FR 4458

Number of Respondents: 1,540	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,540	550	990
Annual IC Time Burden (Hours)	128	45	83
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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