Information Collection

Supplemental NDI Data Use Agreement

IC 282422 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 Data Use Agreement Supplemental NDI Data Use Agreement	Form and Instruction
0920-26-0271 Data Use Agreement OMB0920-0215_Att G2_NDI Supplemental Data Use Agreement.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-26-0271

Is this a Common Form? No

IC Status: New

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: Vital Statistics for Births, Deaths, Fetal Deaths, Marriages and Divorces Occurring in the United States Each Year 09-20-0166

FR Citation: 49 FR 37695

Number of Respondents: 130

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	130	-152	282
Annual IC Time Burden (Hours)	65	42	23
Annual IC Cost Burden (Dollars)	0	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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