View Information Collection (IC)

View Information Collection (IC)

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: 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 and Instruction	57.111	Pneumonia (PNEU)	57.111_PNEU_November_2022.docx	NA	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	3,600	0	0	0	0	3,600
Annual IC Time Burden (Hours)	1,860	0	60	0	0	1,800
Annual IC Cost Burden (Dollars)	0	0	-71,388	0	0	71,388

Documents for IC

Title	Document	Date Uploaded
TOI Instructions	TOI COVID 19_57.111_PNEU Event (1).docx	06/04/2020
57.111 PNEU with GISAB edits in tracked changes	57.111_PNEU_November_2022.docx	04/24/2023

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