Information Collection

Monthly Vital Statistics Report

IC 6670 under ICR 201602-0920-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.