OMB control number
Project NICE: Navigating Insurance Coverage Expansion
OMB 0920-1239 ยท HHS/CDC.
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 is listed under ICR 201806-0920-009.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 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All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201806-0920-009 | New collection (Request for a new OMB Control Number) | 2018-06-27 | Approved without change |
OMB Details
Att 5_Participant Eligiility Form
Federal Enterprise Architecture: Health - Illness Prevention
| Form | Name | Electronic access | Type |
|---|---|---|---|
| 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.