National Death Index- Repeat Request Form

Application Form and Related Forms for the Operation of the National Death Index

OMB: 0920-0215

IC ID: 182823

Information Collection (IC) Details

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National Death Index- Repeat Request Form
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form N/A NDI Repeat Request Form Att C Repeat Request Form 120816.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

09-20-0166 Vital Statistics for Births, Deaths, Fetal Deaths, Marriages and Divorces Occurring in the US During Each Year  49 FR 37695

70 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 70 0 0 0 0 70
Annual IC Time Burden (Hours) 21 0 0 0 0 21
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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