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.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
NDI - Application Form (paper)	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
NDI - Repeat Request Form	Form and Instruction
Att G IRB.pdf	Supplementary Document
Att F National Death Index Advisors.docx (document unavailable)	Supplementary Document
Att B Published 60-Day FRN.pdf	Supplementary Document
Att A Authorizing Legislation.docx	Supplementary Document
NDI Sup St B_1_31_23.docx (document unavailable)	Supporting Statement B
NDI Sup St A_1_31_23_final_Final.docx	Supporting Statement A
NDI - Application Form (paper)	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
NDI - Repeat Request Form	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
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
Form	Name	Electronic access	Type
Form n/a	National Death Index Application Form	Paper Only	Form and instruction

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