Monthly Vital Statistics Report

NCHS: National Vital Statistics Report Forms

⚠️ Notice: This information collection may be referencing outdated material.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
Monthly Vital Statistics Report (rev 2016) 0920-0213 Att A Monthly Form 011416.doc Form
Monthly Vital Statistics Report 0920-0213 Att B Annual Form 011116.doc Form
0920-0213 Att C Monthly Form 012915.doc Att C_Currently Approved Version IC Document

Information Collection (IC) Details

IC Title:	Monthly Vital Statistics Report	Agency IC Tracking Number:	16LU

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Monthly Vital Statistics Report	Att B Monthly Form 012915.doc	Yes	Yes	Fillable Fileable
Form	none	Monthly Vital Statistics Report (rev 2016)	0920-0213 Att A Monthly Form 011416.doc	Yes	Yes	Fillable Fileable
Form	NA	Monthly Vital Statistics Report	0920-0213 Att B Annual Form 011116.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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,092	0	1,092
Annual IC Time Burden (Hours)	146	-36	182
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Att C_Currently Approved Version	0920-0213 Att C Monthly Form 012915.doc	02/11/2016

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.