Information Collection

Survey to evaluate the Nursing Home Infection Preventionist Training Course

IC 235788 under ICR 201711-0920-019 · OMB 0920-1071.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1071 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Survey to evaluate the Nursing Home Infection Preventionist Training Course	Form and Instruction
Evaluation of the Nursing Home Infection Preventionist T NH IP Course Eval_Clean.docx	Form and Instruction
Instructions for completing the NH IP Course Eval_Clean.docx Instructions for completing NH IP Training Course	IC Document
040919MS-NR-signed.pdf Non-Research Determination	IC Document
GenIC Request - Revised_19APR2019.docx GenIC Request	IC Document

IC Title:

Survey to evaluate the Nursing Home Infection Preventionist Training Course

Agency IC Tracking Number:

0920-1071-19AOJ

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	NA	Evaluation of the Nursing Home Infection Preventionist Training Course	NH IP Course Eval_Clean.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	583	583
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Instructions for completing NH IP Training Course	Instructions for completing the NH IP Course Eval_Clean.docx	04/19/2019
Non-Research Determination	040919MS-NR-signed.pdf	04/19/2019
GenIC Request	GenIC Request - Revised_19APR2019.docx	04/19/2019

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