Information Collection

Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report

IC 199058 under ICR 201407-0920-012 · OMB 0920-0004.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0004 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CDC 43.5 Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report	Form
CMRS Weekly 122 CMRS weekly mortality form.pdf	Form
CDC 43.5 122 CMRS-City Health Officers or Vital Statistics Regist Att R_122 CMRS - city health officers or vital statistics registrars weekly mortality report.pdf	Form

IC Title:

Att R_CMRS - City Health Officer or Vital Statistics Registrars Weekly Mortality Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CDC 43.5	122 CMRS-City Health Officers or Vital Statistics Registrars Weekly Mortality Report	Att R_122 CMRS - city health officers or vital statistics registrars weekly mortality report.pdf		Yes	Yes	Fillable Printable
Form	none	CMRS Weekly	122 CMRS weekly mortality form.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 122

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 62 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	6,344	6,344
Annual IC Time Burden (Hours)	1,269	1,269
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.