OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

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

OMB 0920-0215 · HHS/CDC.

OMB 0920-0215

The National Death Index (NDI) and the services it provides allows NCHS to collect mortality data to support epidemiological research and to furnish mortality information to approved public health and medical investigators. This is a Revision request for a three-year clearance to use of the administrative forms (the application form, repeat request form, and transmittal form) and the fee worksheets utilized in the operation of the National Death Index (NDI) program.

The latest form for [NCHS] Application Form and Related Forms for the Operation of the National Death Index expires 2026-07-31 and is listed under ICR 202301-0920-012.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 0920-26-0271 Data Use AgreementForm and Instruction
Form 0920-26-0271 Data Use AgreementForm and Instruction
Form 0920-26-0271 Data Destruction FormForm and Instruction
Form 0920-26-0271 NDI Early Release Fee WorksheetForm and Instruction
Form 0920-26-0271 NDI Fee WorksheetForm and Instruction
Form 0920-26-0271 National Death Index Early Release Transmittal FormForm and Instruction
Form 0920-26-0271 National Death Index Application FormForm and Instruction
Form 0920-26-0271 National Death Index Transmittal FormForm and Instruction
OMB0920-0215_Att I_IRB-ERB Letter_30d NDI Forms.pdfSupplementary Document
OMB0920-0215_Att H_NDI Advisory Board Members v2.docxSupplementary Document
OMB0920-0215_Att B2_Public Comment to the 60-Day Federal Register Notice and Program Response.docxPublic Comments
OMB0920-0215_Att A_Authorizing Legislation_30d NDI Forms.docxSupplementary Document
Att G IRB.pdfSupplementary Document
Att F National Death Index Advisors.docxSupplementary Document
Att B Published 60-Day FRN.pdfSupplementary Document
Att A Authorizing Legislation.docxSupplementary Document
OMB0920-0215_Sup St B_30d NDI Forms v2_TM.docxSupporting Statement B
OMB0920-0215_Sup St A_30d NDI Forms v2_TM.docxSupporting Statement A
Supplemental NDI Data Use Agreement Form and Instruction
NDI Data Use Agreement Form and Instruction
Data Destruction Form Form and Instruction
NDI - Early Release Fee Worksheet Form and Instruction
NDI - Fee Worksheet Form and Instruction
NDI Early Relase Transmittal Form Form and Instruction
NDI - Application Form (electronic) Form and Instruction
NDI - Transmittal Form Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202609-0920-003 Reinstatement with change of a previously approved collection 2026-09-14
202301-0920-012 Revision of a currently approved collection 2023-02-08 Approved without change
201912-0920-014 Reinstatement with change of a previously approved collection 2020-01-31 Approved without change
201903-0920-004 No material or nonsubstantive change to a currently approved collection 2019-03-11 Approved without change
201610-0920-008 Revision of a currently approved collection 2016-10-14 Approved without change
201309-0920-006 Extension without change of a currently approved collection 2013-09-16 Approved without change
201010-0920-004 Extension without change of a currently approved collection 2010-10-12 Approved without change
200711-0920-012 Revision of a currently approved collection 2007-11-21 Approved without change
200409-0920-006 Extension without change of a currently approved collection 2004-09-27 Approved without change
200208-0920-010 No material or nonsubstantive change to a currently approved collection 2002-08-23 Approved without change
200109-0920-001 Extension without change of a currently approved collection 2001-09-13 Approved without change
199808-0920-003 Extension without change of a currently approved collection 1998-08-17 Approved without change
199506-0920-004 Extension without change of a currently approved collection 1995-06-23 Approved without change
199206-0920-002 Extension without change of a currently approved collection 1992-06-19 Approved without change
198905-0920-003 Revision of a currently approved collection 1989-05-15 Approved without change
198802-0920-009 Extension without change of a currently approved collection 1988-02-16 Approved without change

OMB Details

NDI - Application Form (paper)

Federal Enterprise Architecture: Health - Public Health Monitoring

Information collection instruments
FormNameElectronic accessType
Form n/aNational Death Index Application FormPaper OnlyForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.