Information Collection

NDI - Application Form (electronic)

IC 239461 under ICR 202609-0920-003 · OMB 0920-0215.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-26-0271 National Death Index Application Form NDI - Application Form (electronic)	Form and Instruction
0920-26-0271 National Death Index Application Form OMB0920-0215_Att C_NDI Application.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-26-0271

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	0920-26-0271				Yes	Yes	Fillable Fileable

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: 282

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	282	282
Annual IC Time Burden (Hours)	705	705
Annual IC Cost Burden (Dollars)	0	0

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.

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