National Survey of Medical Examiners

Determining Causes of Sudden, Unexpected Infant Death: A National Survey of U.S. Medical Examiners and Coroners

Documents and Forms

Document Name Document Type
Att 3_Questionnaire.docx Other-WORD
Att 4b_Survey Cover Letter.docx Att 4b_Survey Cover Letter IC Document
Att 4c_Reminder_Thank You Postcard.docx Att 4c_Reminder_Thank You Postcard IC Document
Att 4d_Reminder Call.docx Att 4d_Reminder Call IC Document

Information Collection (IC) Details

IC Title:	National Survey of Medical Examiners	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
Other-WORD			Att 3_Questionnaire.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 576	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: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	576	576
Annual IC Time Burden (Hours)	288	288
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 4b_Survey Cover Letter	Att 4b_Survey Cover Letter.docx	08/27/2013
Att 4c_Reminder_Thank You Postcard	Att 4c_Reminder_Thank You Postcard.docx	08/27/2013
Att 4d_Reminder Call	Att 4d_Reminder Call.docx	08/27/2013

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