NCHS: National Vital Statistics Report Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Monthly Vital Statistics Report	Form	Modified	Available
Annual Vital Statistics Occurence Report	Form	Modified	Repair queued
Att E IRB letter.doc	Supplementary Document	Uploaded 2015-02-26	Available
Att D FedReg PubCom.doc	Supplementary Document	Uploaded 2015-02-26	Available
NVSR 2015-18 Supp St B.doc	Supporting Statement B	Uploaded 2015-02-26	Available
NVSR 2015-18 Supp St A 021215.docx	Supporting Statement A	Uploaded 2015-02-26	Available
NVSReport Att A LegisAuth.pdf	Supplementary Document	Uploaded 2012-02-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6670	Monthly Vital Statistics Report	Form	Modified
188714	Annual Vital Statistics Occurence Report	Form	Modified

ICR Details

OMB Control No: 0920-0213	ICR Reference No: 201502-0920-017
Status: Historical Active	Previous ICR Reference No: 201202-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: NCHS: National Vital Statistics Report Forms
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/10/2015
	Date Received in OIRA: 03/06/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	36 Months From Approved	04/30/2015
Responses	1,150	0	1,150
Time Burden (Hours)	211	0	211
Cost Burden (Dollars)	0	0	0

---

Abstract: These are the data collection forms used by State and/or county vital registration offices to report to the Federal government (a) provisional counts of births, deaths, infant deaths, marriages, and divorces at the end of each month and (b) annual final counts of marriages and divorces/annulments in support of the National Vital Statistics System.

---

Authorizing Statute(s): US Code: 42 USC 242k Name of Law: Public Health Service
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 64199	10/28/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 10488	02/26/2015
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Monthly Vital Statistics Report	none	Monthly Vital Statistics Report
Annual Vital Statistics Occurence Report	none	Annual Vital Statistics Occurrence Report

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,150	1,150	0	0	0	0
Annual Time Burden (Hours)	211	211	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $100,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/06/2015

---