Information Collection

Non-Participant Coroner/Medical Examiner Form

IC 196029 under ICR 201403-0925-007 · OMB 0925-0281.

Documents and Forms

Document Name Document Type
Form 1 Non-Participant Coroner/Medical Examiner Form Form and Instruction
1 Coroner/Medical Examiner Form Attach 3 Coroner Form.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Non-Participant Coroner/Medical Examiner Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	1	Coroner/Medical Examiner Form	Attach 3 Coroner Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 690	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	690	290	400
Annual IC Time Burden (Hours)	115	48	67
Annual IC Cost Burden (Dollars)	0	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.