Information Collection

Monthly Vital Statistics Report

IC 6670 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0213 Monthly Vital Statistics Report	Form
0920-0213 Annual Vital Statistics Occurance Report Att C Monthly Form 5202020.docx	Form
0920-0213 Annual Vital Statistics Occurance Report Att C Monthly Form 5202020.docx	Form
Attachment E - Example Email Request.docx Example of Email Request	IC Document
Attachment E - Example Email Request.docx Example of Email Request	IC Document

IC Title:

Monthly Vital Statistics Report

Agency IC Tracking Number:

0920-0213

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	0920-0213	Annual Vital Statistics Occurance Report	Att C Monthly 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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	91	-605	696
Annual IC Time Burden (Hours)	46	-47	93
Annual IC Cost Burden (Dollars)	300	-1,997	2,297

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Example of Email Request	Attachment E - Example Email Request.docx	05/13/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.