Information Collection

IHS White Earth Hand Washing Survey

IC 230260 under ICR 202201-0917-001 · OMB 0917-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0917-0036 IHS White Earth Hand Washing Survey	Form and Instruction
0917-0036 Hand Washing Survey WESU FEB 2018 Patient assessment of HCP Hand Hygiene.pdf	Form and Instruction
0917-0036 Hand Washing Survey WESU FEB 2018 Patient assessment of HCP Hand Hygiene.pdf	Form and Instruction
WESU FEB 2018 Pt Assessment of Hand Hygeine Clearance Submission Template - IHS.pdf IHS White Earth Hand Washing submission form	IC Document
WESU FEB 2018 Pt Assessment of Hand Hygeine Clearance Submission Template - IHS.pdf IHS White Earth Hand Washing submission form	IC Document

IC Title:

IHS White Earth Hand Washing Survey

Agency IC Tracking Number:

IC Status: Unchanged

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

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 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.