Survey to evaluate the Nursing Home Infection Preventionist Training Course

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.