Information Collection

NDI - Repeat Request Form

IC 182823 under ICR 202301-0920-012 · OMB 0920-0215.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
NDI - Repeat Request Form	Form and Instruction
National Death Index Repeat Request Form Att D Repeat Request Form 120619.pdf	Form and Instruction
National Death Index Repeat Request Form Att D Repeat Request Form 120619.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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 and Instruction	n/a	National Death Index Repeat Request Form	Att D Repeat Request Form 120619.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: 09-20-0166 Vital Statistics for Births, Deaths, Fetal Deaths, Marriages and Divorces Occurring in the US During Each Year

FR Citation: 49 FR 37695

Number of Respondents: 140

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-140	140
Annual IC Time Burden (Hours)	-42	42
Annual IC Cost Burden (Dollars)	-1,731	1,731

Documents for IC

table that charts IC Documents
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.