Information Collection

Annual Vital Statistics Occurence Report

IC 188714 under ICR 201803-0920-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Annual Vital Statistics Occurence Report	Form
Annual Vital Statistics Occurrence Report Att D Annual Form.doc	Form
0920-0213 Att D Annual Form 012915.doc Att D_Current Approved Version	IC Document

IC Title:

Annual Vital Statistics Occurence 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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Annual Vital Statistics Occurrence Report	Att D Annual Form.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: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	91	33	58
Annual IC Time Burden (Hours)	46	17	29
Annual IC Cost Burden (Dollars)	1,127	1,127	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att D_Current Approved Version	0920-0213 Att D Annual Form 012915.doc	02/11/2016

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