Information Collection

Annual Vital Statistics Report

IC 188714 under ICR 202203-0920-008 · OMB 0920-0213.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0213 can be found here:

Documents and Forms

Document Name Document Type
Annual Vital Statistics Report Form
Annual Vital Statistics Form Att D Annual Form 5202020.docx Form
Annual Vital Statistics Form Att D Annual Form 5202020.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Vital Statistics Report	Agency IC Tracking Number:	16LU

Is this a Common Form? No		IC Status: Removed

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	none	Annual Vital Statistics Form	Att D Annual Form 5202020.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 91	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-91	91
Annual IC Time Burden (Hours)	-46	46
Annual IC Cost Burden (Dollars)	-1,127	1,127

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.