NDI - Repeat Request Form

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

OMB: 0920-0215

IC ID: 182823

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Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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NDI - Repeat Request Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a National Death Index Repeat Request Form Att D Repeat Request Form 120619.pdf 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

140 0
   
Individuals or Households
 
   90 %

  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 140 0 70 0 70 0
Annual IC Time Burden (Hours) 42 0 21 0 21 0
Annual IC Cost Burden (Dollars) 1,731 0 1,731 0 0 0

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