Sudden Infant Death and Investigation Report Form

CDC I-Catalyst Program

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.