NDI - Application Form (paper)

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

Documents and Forms

Document Name Document Type
NDI - Application Form (paper) Form and Instruction
National Death Index Application Form Att C1 Application Form Paper_121219.docx Form and Instruction
National Death Index Application Form Att C1 Application Form Paper_121219.docx Form and Instruction

Information Collection (IC) Details

IC Title:	NDI - Application Form (paper)	Agency IC Tracking Number:

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 and Instruction	n/a	National Death Index Application Form	Att C1 Application Form Paper_121219.docx		No		Paper Only

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: 10	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-10	10
Annual IC Time Burden (Hours)	-30	30
Annual IC Cost Burden (Dollars)	-1,237	1,237

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.