Information Collection

57.102 - Hospital Respiratory Data Form (Daily - user entry)

IC 269866 under ICR 202502-0920-015 · OMB 0920-1317.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1317 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 57.102 57.102 - Hospital Respiratory Data Form (Daily - user entry)	Form and Instruction
Form 57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024 57.102 - Hospital Respiratory Data Form (Daily - user entry)	Form and Instruction
57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024 57.102 Hospital Respiratory Data Form - Daily Reporting - Clean Version.docx	Form and Instruction
57.102 Hospital Respiratory Data Daily Reporting Form 14AUG2024 57.102 Hospital Respiratory Data Form - Daily Reporting - Clean Version.docx	Form and Instruction

IC Title:

57.102 - Hospital Respiratory Data Form (Daily - user entry)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

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 and Instruction	57.102			N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 492

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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	179,580	179,580
Annual IC Time Burden (Hours)	173,594	173,594
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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