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⚠️ Notice: This information collection may be referencing outdated material.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 (PNEU) 57.111_PNEU_BLANK.DOCX Form
G23. Ventilator Associated Pneumonia.pdf Att G20_Ventilator-Associated Pneumonia 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 (PNEU)	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: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	129,600	129,600
Annual IC Time Burden (Hours)	64,800	64,800
Annual IC Cost Burden (Dollars)	2,569,968	2,569,968

Documents for IC

Title	Document	Date Uploaded
Att G20_Ventilator-Associated Pneumonia	G23. Ventilator Associated Pneumonia.pdf	07/25/2016

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