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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 201010-0920-004 · 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 Modified Repair queued
Form 0920-0215 National Death Index- Request for Repeat Application Form Form Modified Available
Attachment G.pdf Supplementary Document Uploaded 2010-09-23 Available
Attachment F.pdf Supplementary Document Uploaded 2010-09-23 Repair queued
Attachment E.pdf Supplementary Document Uploaded 2010-09-23 Repair queued
Attachment A.pdf Supplementary Document Uploaded 2010-09-23 Available
1NDI Sup St A 2010-2012 091610.docx Supporting Statement A Uploaded 2010-09-23 Available
IC Document Collections
IC IDCollectionTypeStatusForm
6683 National Death Index - Application Form Form Modified
182824 National Death Index - Transmittal Form Form Modified
182823 National Death Index- Request for Repeat Application Form Form Modified
ICR Details
0920-0215 201010-0920-004
Historical Active 200711-0920-012
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 11/02/2010
Retrieve Notice of Action (NOA) 10/12/2010
  Inventory as of this Action Requested Previously Approved
11/30/2013 36 Months From Approved 12/31/2010
240 0 240
182 0 182
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 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
  75 FR 8364 02/24/2010
75 FR 58394 09/24/2010
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 240 240 0 0 0 0
Annual Time Burden (Hours) 182 182 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$50,000
No
No
No
No
No
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.
10/12/2010