NDI - Fee Worksheet

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0215 can be found here:

Documents and Forms

Document Name Document Type
NDI - Fee Worksheet Form and Instruction
NDI Fee Worksheet Att F1 NDI FEE WORKSHEET 120619.xls Form and Instruction

Information Collection (IC) Details

IC Title:	NDI - Fee Worksheet	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 and Instruction	n/a	NDI Fee Worksheet	Att F1 NDI FEE WORKSHEET 120619.xls		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Vital Statistics for Births, Deaths, Marriages and Divorces Occurring in the United States Each Year 09-20-0166	FR Citation: 49 FR 37695

Number of Respondents: 216	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	216	216
Annual IC Time Burden (Hours)	54	54
Annual IC Cost Burden (Dollars)	2,226	2,226

Documents for IC

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.