Information Collection

57.112 Ventilator-Associated Event (VAE)

IC 200377 under ICR 202006-0920-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form CDC 57.112 57.112 Ventilator-Associated Event (VAE) Form
CDC 57.112 Ventilator-associated event COVID-19_FieldAdditon_57.112_VAE_BLANK.docx Form
G22. Ventilator Associated Event.pdf Att G22_Ventilator-Associated Event IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.112 Ventilator-Associated Event (VAE)	Agency IC Tracking Number:	0920-0666

Is this a Common Form? No		IC Status: Modified

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	CDC 57.112	Ventilator-associated event	COVID-19_FieldAdditon_57.112_VAE_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: 5,500	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	Previously Approved
Annual Number of Responses for this IC	27,500	-575	28,075
Annual IC Time Burden (Hours)	13,292	459	12,833
Annual IC Cost Burden (Dollars)	508,970	-10,642	519,612

Documents for IC

Title	Document	Date Uploaded
Att G22_Ventilator-Associated Event	G22. Ventilator Associated Event.pdf	08/08/2016

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