Information Collection

Sudden Infant Death and Investigation Report Form

IC 226562 under ICR 201611-0920-005 · OMB 0920-1158.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1158 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CDC I-Catalyst Interview Guide _Questions Project 6 SUIDIRF 4-26.docx	Other-Interview Guide
Request for Approval GenIC_Clearance- Project 6 NCCDPHP SUIDIRF TONO.DOCX Request for Approval	IC Document
ICatalyst Supporting Statements A SUIDIRF 4-26.docx Supporting Statement A	IC Document

IC Title:

Sudden Infant Death and Investigation Report Form

Agency IC Tracking Number:

17AGN

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Interview Guide			CDC I-Catalyst Interview Guide _Questions Project 6 SUIDIRF 4-26.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	Request for Approval GenIC_Clearance- Project 6 NCCDPHP SUIDIRF TONO.DOCX	04/26/2017
Supporting Statement A	ICatalyst Supporting Statements A SUIDIRF 4-26.docx	04/26/2017

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