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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 201903-0920-004 · OMB 0920-0215 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-0215 National Death Index - Application Form Form Modified Available
National Death Index - Transmittal Form Form Unchanged Available
National Death Index- Repeat Request Form Form Unchanged Available
Att B Highlighted changes to the current NDI Application Form 013019.docx Supplementary Document Uploaded 2019-03-08 Available
NDI nonsub OMB 021319.docx Justification for No Material/Nonsubstantive Change Uploaded 2019-03-08 Available
Att G IRB.pdf Supplementary Document Uploaded 2016-10-14 Available
Att F Advisors 092816.docx Supplementary Document Uploaded 2016-10-14 Available
Att E2 Federal Register Comments.docx Supplementary Document Uploaded 2016-10-14 Repair queued
Att E1 60-day notice 072116.pdf Supplementary Document Uploaded 2016-10-14 Available
Att A Authorizing Legislation.docx Supplementary Document Uploaded 2016-10-14 Available
NDI Sup St A 120916.docx Supporting Statement A Uploaded 2016-12-09 Available
IC Document Collections
IC IDCollectionTypeStatusForm
6683 National Death Index - Application Form Form Modified
182824 National Death Index - Transmittal Form Form Unchanged
182823 National Death Index- Repeat Request Form Form Unchanged
ICR Details
0920-0215 201903-0920-004
Historical Active 201610-0920-008
HHS/CDC 20486
Application Form and Related Forms for the Operation of the National Death Index
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 03/14/2019
Retrieve Notice of Action (NOA) 03/11/2019
  Inventory as of this Action Requested Previously Approved
12/31/2019 12/31/2019 12/31/2019
290 0 290
457 0 507
0 0 0
CDC requests to continue data collection for 3 years, with changes. 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. This Non-Substantive change request for the National Death Index (NDI) is for formatting and minor question rewording and modifications designed to enhance the document flow. Overall burden will be reduced by 50 burden hours.
US Code: 42 USC 306 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  81 FR 140 07/21/2016
81 FR 199 10/14/2016
Yes
  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 290 290 0 0 0 0
Annual Time Burden (Hours) 457 507 0 -50 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
Theis Non-Substantive Change Request results in a reduction in burden for the NDI - Application Form from 4.5 to 4 hours and the overall burden for the entire project from 507 hours to 457.
$133,000
No
    Yes
    Yes
No
No
No
Uncollected
Jeffrey Zirger 404 639-7118 [email protected]
  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.
03/11/2019