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Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 199808-0920-003 · OMB 0920-0215 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
6681 Application Form and Related Forms for the Operation of the National Death Index Form Migrated
ICR Details
0920-0215 199808-0920-003
Historical Active 199506-0920-004
HHS/CDC
Application Form and Related Forms for the Operation of the National Death Index
Extension without change of a currently approved collection   No
Regular
Approved without change 10/16/1998
Retrieve Notice of Action (NOA) 08/17/1998
Approved for use through 10/2001 with the understanding that NCHS will formally submit for PRA review any revisions to these forms, including the anticipated amendments to the National Death Index Application Form.
  Inventory as of this Action Requested Previously Approved
11/30/2001 11/30/2001 10/31/1998
780 0 780
227 0 227
0 0 0
Researchers apply to use the National Death Index (NDI) to determine whether persons in their studies have died and to obtain the States of death and death certificate numbers of the decedents. The five administrative forms are completed by researchers in order to apply for NDI services and to submit records of study subjects for computer matching against the NDI file.
None
None
No
1
IC Title Form No. Form Name
Application Form and Related Forms for the Operation of the National Death Index CDC/NCHS-6205-1, CDC-6424, CDC-6425, CDC-6426, PHS-6205-3
  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 780 780 0 0 0 0
Annual Time Burden (Hours) 227 227 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
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.
08/17/1998