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Federal forms, ICRs, and supporting documents

Information Collection Request

Assessment of Demographic Information on Death Certificates Survey

ICR 199506-0920-001 · OMB 0920-0368 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
111106 Assessment of Demographic Information on Death Certificates Survey Migrated
ICR Details
0920-0368 199506-0920-001
Historical Active
HHS/CDC
Assessment of Demographic Information on Death Certificates Survey
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 06/09/1995
Retrieve Notice of Action (NOA) 06/07/1995
  Inventory as of this Action Requested Previously Approved
06/30/1998 06/30/1998
100 0 0
100 0 0
0 0 0
Demographic characteristics of decedents collected on death certificates are a critical source of information for public health surveillance, analysis, and program planning. The information is used in the tracking and analysis of diseases and injuries occurring among different subgroups in the population, which is integral to the mission of CDC. The purpose of this survey is to ascertain the methods currently used by funeral directors.
None
None
No
1
IC Title Form No. Form Name
Assessment of Demographic Information on Death Certificates Survey
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 100 0 0 100 0 0
Annual Time Burden (Hours) 100 0 0 100 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/07/1995