OMB control number

HIV prevention among Latina transgender women who have sex with men: Evaluation of a locally developed intervention

OMB 0920-1266 · HHS/CDC.

OMB 0920-1266

The purpose of this study is to evaluate the efficacy of ChiCAS (Chicas Creando Acceso a la Salud [Chicas: Girls Creating Access to Health]), a Spanish language intervention that provides HIV prevention services to Hispanic/Latina adult transgender women. The information collected through this study will be used to evaluate whether exposure to the ChiCAS intervention results in improvements in participants' self-reported HIV prevention behaviors, beliefs and attitudes. This study will use a randomized delayed-intervention comparison group design to compare pre- (baseline) and post-intervention (6-month) levels of HIV risk among participants who have received the intervention and participants who have not yet received the intervention (delayed intervention group).

The latest form for HIV prevention among Latina transgender women who have sex with men: Evaluation of a locally developed intervention expires 2021-06-30 and is listed under ICR 201902-0920-019.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form 0920-1266 Follow Up Questionnaire	Form and Instruction
Interview	Form and Instruction
Baseline Questionnaire	Form and Instruction
Contact Information	Form and Instruction
Eligibility Screener	Form and Instruction
SSA ChiCAS_06.21.21_Revised.docx	Supporting Statement A
SSB ChiCAS 22Jan2021_Clean_CAG_02.04.21.docx	Supporting Statement B
Att 10b_ChiCAS Appointment Card Spanish.docx	Supplementary Document
Att 10a_ChiCAS Appointment Card English.docx	Supplementary Document
Att 9b_ChiCAS Stay in Touch Spanish.docx	Supplementary Document
Att 9a_ChiCAS Stay in Touch English.docx	Supplementary Document
Att 8_PIA 0920-18AQQ.pdf	Supplementary Document
Att 7_ChiCAS Data Use Plan.docx	Supplementary Document
Att 6h_ChiCAS IRB Amendment Catchment.pdf	Supplementary Document
Att 6g_ChiCAS IRB Amendment Lewis.pdf	Supplementary Document
Att 6f_ChiCAS IRB Amendment Virtual and OraQuick.pdf	Supplementary Document
Att 6e_ChiCAS IRB Amendment Token.pdf	Supplementary Document
Att 6d_ChiCAS IRB Assessment Amendment.pdf	Supplementary Document
Att 6c_ChiCAS IRB UNC Agreement.pdf	Supplementary Document
Att 6b_ChiCAS IRB Triad Agreement.pdf	Supplementary Document
Att 6a_ChiCAS IRB Approval.pdf	Supplementary Document
Att 5b_ChiCAS Consent Spanish.docx	Supplementary Document
Att 5a_ChiCAS Consent English.docx	Supplementary Document
Att 3b_ChiCAS Recruitment Materials Spanish.pdf	Supplementary Document
Att 3a_ChiCAS Recruitment Materials English.pdf	Supplementary Document
Att 2a_Public Comments.docx	Supplementary Document
Att 2 60 day FRN Published 2-25-2021.pdf	Supplementary Document
Att 10b_ChiCAS Appointment Card Spanish.docx	Supplementary Document
Att 10a_ChiCAS Appointment Card English.docx	Supplementary Document
Att 9b_ChiCAS Stay in Touch Spanish.docx	Supplementary Document
Att 9a_ChiCAS Stay in Touch English.docx	Supplementary Document
Att 1_Authorizing Legislation.docx	Supplementary Document
Follow Up Questionnaire	Form and Instruction
Interview	Form and Instruction
Baseline Questionnaire	Form and Instruction
Contact Information	Form and Instruction
Eligibility Screener	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
202106-0920-005	Revision of a currently approved collection	2021-06-24		Approved without change
201902-0920-019	New collection (Request for a new OMB Control Number)	2019-03-11		Approved with change

OMB Details

Eligibility Screener

Federal Enterprise Architecture: Health - Public Health Monitoring

Information collection instruments
Form	Name	Electronic access	Type
Form NA	ChiCAS Screener - Spanish	NA	Form and instruction
Form NA	ChiCAS Screener - Spanish	NA	Form and instruction
Form NA	ChiCAS Screener - English	NA	Form and instruction
Form NA	ChiCAS Screener - English	NA	Form and instruction

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