View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	IHS White Earth Hand Washing Survey	Agency IC Tracking Number:	85

IC Status: New

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	0917-0036	Hand Washing Survey	WESU FEB 2018 Patient assessment of HCP Hand Hygiene.pdf		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	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	500	0	500	0	0	0
Annual IC Time Burden (Hours)	25	0	25	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
IHS White Earth Hand Washing submission form	WESU FEB 2018 Pt Assessment of Hand Hygeine Clearance Submission Template - IHS.pdf	02/26/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.