Patient Centered Hand Hygiene Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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

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 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

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.