Information Collection

Ventilated Patient Form

IC 276085 under ICR 202604-0906-002 · OMB 0906-0112.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Ventilated Patient Form Ventilated Patient Form	Form
Form 1 Ventilated Patient Form Ventilated Patient Form	Form
04292026 - Ventilated Patient Form (VPF) – Instructions - CLEAN.docx	Instruction
04292026 - Ventilated Patient Form (VPF) – Instructions - CLEAN.docx	Instruction
1 Ventilated Patient Form 04292026 - Ventilated Patient Form (VPF) – Data Fields - CLEAN.xlsx	Form
1 Ventilated Patient Form 04292026 - Ventilated Patient Form (VPF) – Data Fields - CLEAN.xlsx	Form
REDLINE Ventilated Patient Form OPTN Data Process 0906-NEW 11202025.pdf REDLINE Ventilated Patient Form OPTN Data Process 0906-NEW 11202025	IC Document
REDLINE Ventilated Patient Form OPTN Data Process 0906-NEW 11202025.pdf REDLINE Ventilated Patient Form OPTN Data Process 0906-NEW 11202025	IC Document
REDLINE Ventilated Patient Form Instructions - OPTN Process Data 0906-NEW 11202025.pdf REDLINE Ventilated Patient Form Instructions - OPTN Process Data 0906-NEW 11202025	IC Document
REDLINE Ventilated Patient Form Instructions - OPTN Process Data 0906-NEW 11202025.pdf REDLINE Ventilated Patient Form Instructions - OPTN Process Data 0906-NEW 11202025	IC Document
04292026 - Ventilated Patient Form (VPF) – Instructions - REDLINE.pdf 04292026 - Ventilated Patient Form (VPF) – Instructions - REDLINE	IC Document
04292026 - Ventilated Patient Form (VPF) – Instructions - REDLINE.pdf 04292026 - Ventilated Patient Form (VPF) – Instructions - REDLINE	IC Document
04292026 - Ventilated Patient Form (VPF) – Data Fields - REDLINE.xlsx 04292026 - Ventilated Patient Form (VPF) – Data Fields - REDLINE	IC Document
04292026 - Ventilated Patient Form (VPF) – Data Fields - REDLINE.xlsx 04292026 - Ventilated Patient Form (VPF) – Data Fields - REDLINE	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Ventilated Patient Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	1				Yes	Yes	Fillable Fileable
Instruction					Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Privacy Act System of Records

FR Citation: 87 FR 46967

Number of Respondents: 56

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	105,095	105,095
Annual IC Time Burden (Hours)	38,885	38,885
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
REDLINE Ventilated Patient Form OPTN Data Process 0906-NEW 11202025		12/01/2025
REDLINE Ventilated Patient Form Instructions - OPTN Process Data 0906-NEW 11202025		12/01/2025
04292026 - Ventilated Patient Form (VPF) â Instructions - REDLINE		04/29/2026
04292026 - Ventilated Patient Form (VPF) â Data Fields - REDLINE		04/29/2026

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

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