Information Collection

Death Notification Referal - Eligible

IC 194823 under ICR 201411-0915-004 · OMB 0915-0157.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0157 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Death Notification Referal - Eligible Form
Death Notification Registration Instructions.pdf Instruction
1 Death Notification Referral Eligible Death Notification Registration Worksheet.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Death Notification Referal - Eligible	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Death Notification Referral Eligible	Death Notification Registration Worksheet.pdf		Yes	Yes	Fillable Fileable
Instruction			Death Notification Registration Instructions.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 58	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: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-8,410	8,410
Annual IC Time Burden (Hours)	-4,205	4,205
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.