Information Collection

NDI - Application Form (paper)

IC 6683 under ICR 202301-0920-012 · OMB 0920-0215.

Documents and Forms

Documents and forms in this information collection
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

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 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 %

table that charts list of burden
	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

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.