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Federal forms, ICRs, and supporting documents

Information Collection

Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram)

IC 183549 under ICR 200908-0920-002 · OMB 0920-0666.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 57.75G, 57.75Ga, 5
Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram)		 Form and Instruction
57.75G, 57.75Ga, 5 Pneumonia (includes Any Patient Pneumonia Flow Diagram a
G_PNEU.ppt 		Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 57.75G, 57.75Ga, 57.75Gb Pneumonia (includes Any Patient Pneumonia Flow Diagram and Infant and Children Pneumonia Flow Diagram) G_PNEU.ppt Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 432,000 0 0 0 0 432,000
Annual IC Time Burden (Hours) 216,000 0 0 0 0 216,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.