57.112 Ventilator-Associated Event (VAE)

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⚠️ Notice: This information collection may be referencing outdated material.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 57.112 57.112 Ventilator-Associated Event (VAE) Form
CDC 57.112 Ventilator-associated event COVID-19_FieldAdditon_57.112_VAE_BLANK.docx Form
G22. Ventilator Associated Event.pdf Att G22_Ventilator-Associated Event IC Document

Information Collection (IC) Details

IC Title:	57.112 Ventilator-Associated Event (VAE)	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 57.112	Ventilator-associated event	COVID-19_FieldAdditon_57.112_VAE_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: 5,463	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	43,704	16,204	27,500
Annual IC Time Burden (Hours)	20,395	7,103	13,292
Annual IC Cost Burden (Dollars)	808,874	299,904	508,970

Documents for IC

Title	Document	Date Uploaded
Att G22_Ventilator-Associated Event	G22. Ventilator Associated Event.pdf	08/08/2016

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