Information Collection

57.113 Pediatric Ventilator-Associated Event (PedVAE)

IC 222890 under ICR 202212-0920-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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 57.113 57.113 Pediatric Ventilator-Associated Event (PedVAE) Form
Form CDC 57.113 57.113 Pediatric Ventilator-Associated Event (PedVAE) Form
CDC 57.113 Pediatric Ventilator-associated Event COVID-19_FieldAddition_57.113_Pediatric VAE_BLANK.docx Form
CDC 57.113 Pediatric Ventilator-associated Event COVID-19_FieldAddition_57.113_Pediatric VAE_BLANK.docx Form
57.113 Pediatric Ventilator-Associated Event (PedVAE) 57.113_Pediatric VAE_November_2022.docx Form and Instruction
57.113 Pediatric Ventilator-Associated Event (PedVAE) 57.113_Pediatric VAE_November_2022.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	57.113 Pediatric Ventilator-Associated Event (PedVAE)	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 57.113	Pediatric Ventilator-associated Event	COVID-19_FieldAddition_57.113_Pediatric VAE_BLANK.docx		Yes	Yes	Fillable Fileable
Form and Instruction	57.113	Pediatric Ventilator-Associated Event (PedVAE)	57.113_Pediatric VAE_November_2022.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 334	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	334	334
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	6,623	6,623

Documents for IC

Title	Document	Date Uploaded
No associated records found

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