Information Collection

Patient Centered Hand Hygiene Survey

IC 235304 under ICR 201710-2900-001 · OMB 2900-0770.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-xxxx Patient Centered Hand Hygiene Survey	Form and Instruction
10-xxxx Patient Centered Hand Hygiene Survey Form Patient centered HH survey form.docx	Form and Instruction
10-xxxx Semmelweis Hand Hygiene Survey Form - 6 per sheet Semmelweis0708.doc	Form and Instruction
Ignaz Philipp Semmelweis v7.docx Ignaz Semmelweis Hand Hygiene Program Talking Points	IC Document
hh_monograph jt comm.pdf Measuring Hand Hygiene Adherence	IC Document
Copy of HH survey areas and dates.xlsx Hand Hygiene Survey Areas and Dates	IC Document
Patient Centered Hand Hygiene Survey_Generic Clearance Statement.doc Hand Hygiene Patient Survey Generic Clearance Statement	IC Document

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:

table that charts list of 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

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,440	1,440
Annual IC Time Burden (Hours)	48	48
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.