Annual Vital Statistics Occurence Report

National Vital Statistics Report Forms

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0213 can be found here:

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.