Information Collection

Ventilated Patient Form

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

Documents and Forms

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Ventilated Patient Form	04292026 - Ventilated Patient Form (VPF) â Data Fields - CLEAN.xlsx		Yes	Yes	Fillable Fileable
Instruction			04292026 - Ventilated Patient Form (VPF) â Instructions - CLEAN.docx		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 %

	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

Title	Document	Date Uploaded
REDLINE Ventilated Patient Form OPTN Data Process 0906-NEW 11202025	REDLINE Ventilated Patient Form OPTN Data Process 0906-NEW 11202025.pdf	12/01/2025
REDLINE Ventilated Patient Form Instructions - OPTN Process Data 0906-NEW 11202025	REDLINE Ventilated Patient Form Instructions - OPTN Process Data 0906-NEW 11202025.pdf	12/01/2025
04292026 - Ventilated Patient Form (VPF) â Instructions - REDLINE	04292026 - Ventilated Patient Form (VPF) â Instructions - REDLINE.pdf	04/29/2026
04292026 - Ventilated Patient Form (VPF) â Data Fields - REDLINE	04292026 - Ventilated Patient Form (VPF) â Data Fields - REDLINE.xlsx	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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