National Vital Statistics Report Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Monthly VItal Statistics Report	Form	Modified	Available
Annual Vital Statistics Form	Form	Modified	Repair queued
Att E IRB letter.docx	Supplementary Document	Uploaded 2020-08-12	Available
Att B Published 60 Day FRN.pdf	Supplementary Document	Uploaded 2020-08-12	Available
Att A LegisAuth.pdf	Supplementary Document	Uploaded 2020-08-12	Available
Supp St B 05212020.docx	Supporting Statement B	Uploaded 2020-08-12	Available
Supp St A 07072020.docx	Supporting Statement A	Uploaded 2020-08-12	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6670	Monthly Vital Statistics Report	Form	Modified	Monthly VItal Statistics Report
188714	Annual Vital Statistics Report	Form	Modified	Annual Vital Statistics Form

ICR Details

OMB Control No: 0920-0213	ICR Reference No: 202008-0920-006
Status: Historical Active	Previous ICR Reference No: 201803-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0213
Title: National Vital Statistics Report Forms
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/16/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/24/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2023	36 Months From Approved	04/30/2021
Responses	787	0	787
Time Burden (Hours)	139	0	139
Cost Burden (Dollars)	3,424	0	3,424

---

Abstract: These are the data collection forms used by State and/or county vital registration offices to report to the Federal government (a) provisional counts of births, deaths, and infant deaths at the end of each month and (b) annual counts of marriages and divorces/annulments in support of the National Vital Statistics System.

---

Authorizing Statute(s): US Code: 42 USC 242k Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 34635	06/05/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 51436	08/20/2020
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Monthly Vital Statistics Report	none	Monthly VItal Statistics Report
Annual Vital Statistics Report	none	Annual Vital Statistics Form

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	787	787	0	0	0	0
Annual Time Burden (Hours)	139	139	0	0	0	0
Annual Cost Burden (Dollars)	3,424	3,424	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $100,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/24/2020

---