View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0920-1266	ICR Reference No: 202106-0920-005
Status: Historical Active	Previous ICR Reference No: 201902-0920-019
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1266
Title: HIV prevention among Latina transgender women who have sex with men: Evaluation of a locally developed intervention
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/15/2021
	Date Received in OIRA: 06/24/2021
Terms of Clearance: Previous terms continue: Approved consistent with the understanding that CDC will not be conducting any general research on the information collected. When communicating findings from this collection, all publications will clearly describe the scope and limitations of the study findings.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2023	24 Months From Approved	11/30/2021
Responses	365	0	365
Time Burden (Hours)	154	0	171
Cost Burden (Dollars)	0	0	0

Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Baseline Questionnaire	0920-1266, 0920-1266, NA, NA, NA, NA	, , , , ,
Contact Information	0920-1266, 0920-1266, NA , NA, NA, NA	, , , , ,
Eligibility Screener	0920-1266, 0920-1266, NA, NA, NA, NA	, , , , ,
Follow Up Questionnaire	0920-1266, 0920-1266	,
Interview	0920-1266, 0920-1266, NA, NA	, , ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	365	365	0
Annual Time Burden (Hours)	154	171	-17
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Revision of 0920-1266 includes removal of redundant questions and division of survey into Baseline and FollowUp resulting in decreased burden.

Annual Cost to Federal Government: $695,535

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Jeffrey Zirger 404 639-7118 wtj5@cdc.gov

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