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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Patient Centered Hand Hygiene Survey
Agency IC Tracking Number:
2900-0770
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
10-xxxx
Patient Centered Hand Hygiene Survey Form
Patient centered HH survey form.docx
No
Paper Only
Form and Instruction
10-xxxx
Semmelweis Hand Hygiene Survey Form - 6 per sheet
Semmelweis0708.doc
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:
1,440
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
1,440
0
1,440
0
0
0
Annual IC Time Burden (Hours)
48
0
48
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Ignaz Semmelweis Hand Hygiene Program Talking Points
Ignaz Philipp Semmelweis v7.docx
03/12/2019
Measuring Hand Hygiene Adherence
hh_monograph jt comm.pdf
03/12/2019
Hand Hygiene Survey Areas and Dates
Copy of HH survey areas and dates.xlsx
03/12/2019
Hand Hygiene Patient Survey Generic Clearance Statement
Patient Centered Hand Hygiene Survey_Generic Clearance Statement.doc
04/01/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.