Information Collection

Standard Data Items Collected

IC 237544 under ICR 201908-0920-003 · OMB 0920-0469.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0469 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0469 Standard Data Items Collected	Form and Instruction
0920-0469 Data Items Collected 0469 NPCR CSS Att 3a Data Items by Diagnosis Year 1995-2017 Final.pdf	Form and Instruction

IC Title:

Standard Data Items Collected

Agency IC Tracking Number:

0920-0469

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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 and Instruction	0920-0469	Data Items Collected	0469 NPCR CSS Att 3a Data Items by Diagnosis Year 1995-2017 Final.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Records of Subjects in Health Promotion and Education Studies

FR Citation: 51 FR 42484

Number of Respondents: 50

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
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	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.