Information Collection

Application And Related Forms For The Operation Of The National Death Index

IC 110888 under ICR 198905-0920-003 · OMB 0920-0215.

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Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

APPLICATION AND RELATED FORMS FOR THE OPERATION OF THE NATIONAL DEATH INDEX

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	-2, -3, -4	No	No
Form	-5, -6	No	No
Form	PHS-6205-1	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	288	-76	364
Annual IC Time Burden (Hours)	227	-31	258
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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