Application Form and Related Forms for the Operation of the National Death Index

ICR 200208-0920-010

OMB: 0920-0215

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0920-0215 200208-0920-010
Historical Active 200109-0920-001
HHS/CDC
Application Form and Related Forms for the Operation of the National Death Index
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 08/23/2002
Retrieve Notice of Action (NOA) 08/23/2002
  Inventory as of this Action Requested Previously Approved
11/30/2004 11/30/2004 11/30/2004
780 0 780
227 0 227
0 0 0

Researchers apply to use the National Death Index (NDI) to determine whether persons in their studies have died and to obtain information on the decedents' states of death, date of death, death certificate, death certificate numbers, and causes of death. The five administrative forms are completed by researchers in order to apply for NDI services and to submit their study subjects' records for computer matching against the NDI file.

None
None


No

1
IC Title Form No. Form Name
Application Form and Related Forms for the Operation of the National Death Index CDC/NCHS-6205-1, CDC-6425, CDC-6426, PHS-6205-3

  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 780 780 0 0 0 0
Annual Time Burden (Hours) 227 227 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.
08/23/2002


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