NDI - Fee Worksheet

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

Documents and Forms

Document Name Document Type
NDI - Fee Worksheet Form and Instruction
NDI Fee Worksheet Att E1 NDI FEE WORKSHEET(2020).xls Form and Instruction
NDI Fee Worksheet Att E1 NDI FEE WORKSHEET(2020).xls Form and Instruction
Cover Page E1.docx OMB Control Header and Burden Statement IC Document
Cover Page E1.docx OMB Control Header and Burden Statement IC Document

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: Modified

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 E1 NDI FEE WORKSHEET(2020).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: 450	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	Previously Approved
Annual Number of Responses for this IC	450	234	216
Annual IC Time Burden (Hours)	113	59	54
Annual IC Cost Burden (Dollars)	0	-2,226	2,226

Documents for IC

Title	Document	Date Uploaded
OMB Control Header and Burden Statement	Cover Page E1.docx	02/08/2023

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