Information Collection

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

IC 183549 under ICR 201708-0920-029 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CDC 57.111 57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram)	Form
CDC 57.111 Pneumonia (PNEU) 57.111_PNEU_BLANK.DOCX	Form
G23. Ventilator Associated Pneumonia.pdf Att G20_Ventilator-Associated Pneumonia	IC Document

IC Title:

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

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	CDC 57.111	Pneumonia (PNEU)	57.111_PNEU_BLANK.DOCX		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,800

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	129,600	-302,400	432,000
Annual IC Time Burden (Hours)	64,800	-151,200	216,000
Annual IC Cost Burden (Dollars)	2,569,968	-5,331,024	7,900,992

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att G20_Ventilator-Associated Pneumonia	G23. Ventilator Associated Pneumonia.pdf	07/25/2016

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