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

OMB 0920-1246

The purpose of this data collection is to evaluate the Translife Center (TLC), which provides combination HIV prevention services to adult transgender women at high risk for HIV infection. Data will be used to compare pre-intervention levels of HIV risk to those at 4 and 8 months post-baseline. Data will be gathered by the cooperative agreement awardee, Chicago House & Social Service Agency, and partner organizations, the Ann & Robert H. Lurie Children’s Hospital of Chicago and the University of Illinois at Chicago. Information will be collected through interviewer and self-administered instruments. This change request is due to COVID-19 and changes some collections from in-person to online or phone.

The latest form for Evaluation of TransLife Center (TLC): A Locally-Developed Combination Prevention Intervention for Transgender Women at High Risk of HIV Infection expires 2021-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Staff Interview Form
Participant Interview Form
Follow-up Assessment Form
Baseline Assessment Form
Contact Information Form
Eligibility Screening Form
Summary of Proposed Changes in the ICR for TLC 0920-1246.docx Justification for No Material/Nonsubstantive Change
CDC-Research-Protocol_Form Approved09-21-20_clean.docx Supplementary Document
SSB_08Oct20_clean.docx Supporting Statement B
SSA_08Oct20_clean.docx Supporting Statement A
Att 9_Certificate of Confidentiality.pdf Supplementary Document
Att 8 PIA 18CI Final.pdf Supplementary Document
TG Data Use Plan3Apr2017.docx Supplementary Document
Att 6c_UIC IRB Determination.pdf Supplementary Document
2017-767_Initial IRB approval.pdf Supplementary Document
2017-767_Mod Approval Letter.pdf Supplementary Document
Att 5b_Consent to Interview.pdf Supplementary Document
Appendix D_Adult-consent-COVID_ v10-05-20_clean.docx Supplementary Document
Att 3_Recruitment Materials.doc Supplementary Document
Att 2_60-Day FRN.pdf Supplementary Document
Att 1_Auth Legislation.docx Supplementary Document
Staff Interview Form
Participant Interview Form
Follow-up Assessment Form
Baseline Assessment Form
Contact Information Form
Eligibility Screening Form

All Historical Document Collections

202010-0920-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-10-15
201809-0920-009 Approved with change	New collection (Request for a new OMB Control Number)	2018-09-28
201807-0920-013 Improperly submitted	New collection (Request for a new OMB Control Number)	2018-09-07

OMB Details

Eligibility Screening

Federal Enterprise Architecture: Health - Illness Prevention

Form n/a

TLC Eligibility Screener

Paper Only

Form

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