Information Collection

NDI - Fee Worksheet

IC 239467 under ICR 202301-0920-012 · OMB 0920-0215.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0215 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.