Project NICE: Navigating Insurance Coverage Expansion

OMB 0920-1239

This project will implement and evaluate a structural intervention-point of care, in-person health insurance enrollment assistance at the end of an HIV testing session among eligible Black and Hispanic MSM and Transgender persons age 18 and older living in Chicago, Illinois. Process and outcome data will measure the impact of the intervention on linkage to and retention in HIV-related care, referrals to HIV-associated services, and health outcomes. Cost data will also be collected to assess intervention efficacy.

The latest form for Project NICE: Navigating Insurance Coverage Expansion expires 2021-07-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920 Att 7_Participant Enrollment Form Form
Form 0920- Att 6_Informed Consent Form Form
Form 0920- Att 5_Participant Eligiility Form Form
Att 2a PublicComment.pdf Supplementary Document
Att 8 PIA Project NICE 4-30-18_OCISO final.pdf Supplementary Document
Att 4 UCM IRB approval.pdf Supplementary Document
Att 3 Project Determination_NICE_061917 (002) Fehrs signed.pdf Supplementary Document
Att 2 60-day FRN.docx.pdf Supplementary Document
Att 1 Auth Legislation.docx Supplementary Document
SSB.17AUZ.docx Supporting Statement B
SSA 17AUZ_062618.docx Supporting Statement A
Att 7_Participant Enrollment Form Form
Att 6_Informed Consent Form Form
Att 5_Participant Eligiility Form Form

All Historical Document Collections

201806-0920-009

Approved without change

New collection (Request for a new OMB Control Number)

2018-06-27

OMB Details

Att 5_Participant Eligiility Form

Federal Enterprise Architecture: Health - Illness Prevention

Form 0920-

Project NICE: Navigating Insurance Coverage Expansion - Participant Eligibility Form

Fillable Fileable

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.