Information Collection

State Death Match - Electronic Death Registration

IC 184084 under ICR 201705-0960-006 · OMB 0960-0700.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0700 can be found here:

Documents and Forms

Document Name Document Type
Death Screen Images.pdf Other-Internet Screens for EDR
Instructions and File Format for States' Use.docx Instruction
DFSTATE Format.docx Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Death Match - Electronic Death Registration	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 404.371 20 CFR 404.316 20 CFR 416.912 20 CFR 404.330-341 20 CFR 404.350-352 20 CFR 404.301 20 CFR 404.310-311

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Internet Screens for EDR	Death Screen Images.pdf	Yes	Yes	Fillable Fileable Signable
Instruction	Instructions and File Format for States' Use.docx	No		Paper Only
Instruction	DFSTATE Format.docx	No		Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,182,500	-17,500	2,200,000
Annual IC Time Burden (Hours)	0	0	0
Annual IC Cost Burden (Dollars)	6,918,525	296,525	6,622,000

Documents for IC

Title	Document	Date Uploaded
No associated records found

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