Information Collection

Annual Vital Statistics Occurance Report

IC 6670 under ICR 202509-0920-012 · OMB 0920-0213.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0213 Annual Vital Statistics Occurance Report	Form
Form 0920-0213 Annual Vital Statistics Occurance Report Annual Vital Statistics Occurance Report	Form
Form 0920-0213 ANNUAL VITAL STATISTICS OCCURRENCE REPORT_2025 Annual Vital Statistics Occurance Report	Form and Instruction
0920-0213 Annual Vital Statistics Occurance Report Att C Monthly Form 5202020.docx	Form
0920-0213 Annual Vital Statistics Occurance Report Att C Monthly Form 5202020.docx	Form
0920-0213 ANNUAL VITAL STATISTICS OCCURRENCE REPORT_2025 Attachment C - Annual Vital Statistics Occurrence Report_Final.docx	Form and Instruction
0920-0213 ANNUAL VITAL STATISTICS OCCURRENCE REPORT_2025 Attachment C - Annual Vital Statistics Occurrence Report_Final.docx	Form and Instruction
Attachment E - Example Email Request.docx Example of Email Request	IC Document
Attachment E - Example Email Request.docx Example of Email Request	IC Document

IC Title:

Agency IC Tracking Number:

0920-0213

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	0920-0213				Yes	Yes	Fillable Fileable
Form and Instruction	0920-0213			NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 91

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	91	91
Annual IC Time Burden (Hours)	46	46
Annual IC Cost Burden (Dollars)	300	300

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Example of Email Request		05/13/2022

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

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