Information Collection

Monthly Vital Statistics Report

IC 6670 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⚠️ Notice: This information collection may be referencing outdated material.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
Monthly Vital Statistics Report	Form
Monthly Vital Statistics Report Att C Monthly Form.doc	Form

IC Title:

Monthly Vital Statistics Report

Agency IC Tracking Number:

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	Monthly Vital Statistics Report	Att C Monthly 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: 58

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	696	-396	1,092
Annual IC Time Burden (Hours)	93	-53	146
Annual IC Cost Burden (Dollars)	2,297	2,297	0

Documents for IC

table that charts IC Documents
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.