Information Collection

Monthly Vital Statistics Report

IC 6670 under ICR 201502-0920-017 · OMB 0920-0213.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0213 can be found here:

Documents and Forms

Document Name Document Type
Monthly Vital Statistics Report Form
Monthly Vital Statistics Report Att B Monthly Form 012915.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Monthly Vital Statistics Report	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	none	Monthly Vital Statistics Report	Att B Monthly Form 012915.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 91	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 64 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,092	1,092
Annual IC Time Burden (Hours)	182	182
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.