EMPLOYEE VITAL STATUS LETTER

ICR 198504-0920-001

OMB: 0920-0035

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
110633
Migrated
ICR Details
0920-0035 198504-0920-001
Historical Active 198206-0920-001
HHS/CDC
EMPLOYEE VITAL STATUS LETTER
Extension without change of a currently approved collection   No
Regular
Approved without change 05/16/1985
Retrieve Notice of Action (NOA) 04/29/1985
  Inventory as of this Action Requested Previously Approved
05/31/1988 05/31/1988 07/31/1985
700 0 700
117 0 117
0 0 0

THE VITAL STATUS LETTER IS SENT TO MEMBERS OF A RETROSPECTIVE STUDY POPULATION WHO ARE LOST TO FOLLOW-UP. IT IS NECESSARY TO DETERMINE IF A STUDY PARTICIPANT IS ALIVE OR DECEASED AS OF A GIVEN DATA AND THEN T OBTAIN MEDICAL CERTIFICATION OF CAUSE OF DEATH ON DECEASED PARTICIPANT

None
None


No

1
IC Title Form No. Form Name
EMPLOYEE VITAL STATUS LETTER

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 700 700 0 0 0 0
Annual Time Burden (Hours) 117 117 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/29/1985


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