OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Application form and related forms for the operation of the National Death Index

ICR 200711-0920-012 · OMB 0920-0215 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-0215 National Death Index - Application Form Form Modified Available
Form 0920-0215 National Death Index - Transmittal Form Form New Available
Form 0920-0215 National Death Index- Request for Repeat Application Form Form New Available
NDI NEW Att H SOR notice.pdf Supplementary Document Uploaded 2007-11-05 Available
NDI Att G ERB letter.pdf Supplementary Document Uploaded 2007-11-05 Available
NDI Att. F adv lst_new.doc Supplementary Document Uploaded 2007-11-05 Available
NDI NEW Sup St 2007-10(revised).doc Supporting Statement A Uploaded 2007-11-19 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
6683 National Death Index - Application Form Form Modified
182824 National Death Index - Transmittal Form Form New
182823 National Death Index- Request for Repeat Application Form Form New
ICR Details
0920-0215 200711-0920-012
Historical Active 200409-0920-006
HHS/CDC
Application form and related forms for the operation of the National Death Index
Revision of a currently approved collection   No
Regular
Approved without change 12/14/2007
Retrieve Notice of Action (NOA) 11/21/2007
  Inventory as of this Action Requested Previously Approved
12/31/2010 36 Months From Approved 12/31/2007
240 0 780
182 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 information on the decedents' states, dates of death, death certificate numbers, and causes of death. The five administrative forms are completed by researchers in order to apply for NDI services and to submit their study subjects' records for computer matching against the NDI file.
US Code: 42 USC 306 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  72 FR 5297 02/05/2007
72 FR 6733 11/09/2007
No
  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 240 780 0 -540 0 0
Annual Time Burden (Hours) 182 227 0 -45 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Changing Forms
The total annual hours of reporting burden have decreased somewhat from the 227 hours currently in inventory. The total decreased by 45 hours due to the elimination of two obsolete forms no longer used by the researchers.
$5,000
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Maryam Daneshvar 4046394604
  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.
11/21/2007