National Death Index- Request for Repeat Application Form

Application form and related forms for the operation of the National Death Index

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0215 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0215 National Death Index- Request for Repeat Application Form Form
0920-0215 Repeat Request for Application Form NDI NEW Att C repeat.pdf Form

Information Collection (IC) Details

IC Title:	National Death Index- Request for Repeat Application Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	0920-0215	Repeat Request for Application Form	NDI NEW Att C repeat.pdf	none	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 70	Number of Respondents for Small Entity: 5

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	21	21
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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