National Death Index - Application Form

Application Form and Related Forms for the Operation of the National Death Index

OMB: 0920-0215

IC ID: 6683

Information Collection (IC) Details

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National Death Index - Application Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form N/A NDI Application Form Att B NDI Application Form 120816.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

09-20-0166 Vital Statistics for Births, Deaths, Fetal Deaths, Marriages and Divorces Occurring in the US During Each Year  49 FR 37695

100 5
   
State, Local, and Tribal Governments
 
   20 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 100 0 0 50 0 50
Annual IC Time Burden (Hours) 450 0 100 225 0 125
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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