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

The National Healthcare Safety Network (NHSN)

⚠️ Notice: This information collection may be referencing outdated material.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 57.111 57.111 Pneumonia (includes Any Patient Pneumonia flow Diagram and Infant and Children Pneumonia Flow Diagram) Form
CDC 57.111 Pneumonia COVID-19_FieldAddition _57.111_PNEU_BLANK.docx Form
CDC 57.111 Pneumonia COVID-19_FieldAddition _57.111_PNEU_BLANK.docx Form
23. Ventilator Associated Pneumonia.pdf Att G20_Ventilator-Associated Pneumonia IC Document
23. Ventilator Associated Pneumonia.pdf Att G20_Ventilator-Associated Pneumonia IC Document
TOI COVID 19_57.111_PNEU Event (1).docx TOI Instructions IC Document
TOI COVID 19_57.111_PNEU Event (1).docx TOI Instructions IC Document

Information Collection (IC) Details

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: Unchanged

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 57.111	Pneumonia	COVID-19_FieldAddition _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: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	1,800	1,800
Annual IC Cost Burden (Dollars)	71,388	71,388

Documents for IC

Title	Document	Date Uploaded
Att G20_Ventilator-Associated Pneumonia	23. Ventilator Associated Pneumonia.pdf	10/10/2019
TOI Instructions	TOI COVID 19_57.111_PNEU Event (1).docx	06/04/2020

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