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Interview
HIV prevention among Latina transgender women who have sex with men: Evaluation of a locally developed intervention
OMB: 0920-1266
IC ID: 235196
OMB.report
HHS/CDC
OMB 0920-1266
ICR 202106-0920-005
IC 235196
( )
Documents and Forms
Document Name
Document Type
Interview
Form and Instruction
ChiCAS Interview - English 05JUN2019
Att 4e_ChiCAS Interview English_03Oct2018.docx
Form and Instruction
ChiCAS Interview - English 05JUN2019
Att 4e_ChiCAS Interview English_03Oct2018.docx
Form and Instruction
ChiCAS Interview - Spanish 05JUN2019
Att 4f_ChiCAS Interview Spanish_03Oct2018.doc
Form and Instruction
ChiCAS Interview - Spanish 05JUN2019
Att 4f_ChiCAS Interview Spanish_03Oct2018.doc
Form and Instruction
0920-1266 ChiCAS Interview - English JUN2021
Att 4g_ChiCAS Interview English.docx
Form and Instruction
0920-1266 ChiCAS Interview - English JUN2021
Att 4g_ChiCAS Interview English.docx
Form and Instruction
0920-1266 ChiCAS Interview - Spanish JUN2021
Att 4h_ChiCAS Interview Spanish.docx
Form and Instruction
0920-1266 ChiCAS Interview - Spanish JUN2021
Att 4h_ChiCAS Interview Spanish.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Interview
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
NA
ChiCAS Interview - English 05JUN2019
Att 4e_ChiCAS Interview English_03Oct2018.docx
NA
No
Paper Only
Form and Instruction
NA
ChiCAS Interview - Spanish 05JUN2019
Att 4f_ChiCAS Interview Spanish_03Oct2018.doc
NA
No
Paper Only
Form and Instruction
0920-1266
ChiCAS Interview - English JUN2021
Att 4g_ChiCAS Interview English.docx
NA
No
Paper Only
Form and Instruction
0920-1266
ChiCAS Interview - Spanish JUN2021
Att 4h_ChiCAS Interview Spanish.docx
NA
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
15
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
15
0
0
0
0
15
Annual IC Time Burden (Hours)
23
0
0
0
0
23
Annual IC Cost Burden (Dollars)
0
0
0
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.