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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 201912-0920-014 · OMB 0920-0215 · Active

Forms and Documents
DocumentTypeStatusAvailability
NDI - Application Form (paper) Form and Instruction Modified Available
NDI - Early Release Fee Worksheet Form and Instruction New Available
NDI - Fee Worksheet Form and Instruction New Available
NDI Early Relase Transmittal Form Form and Instruction New Repair queued
NDI - Application Form (electronic) Form and Instruction New Repair queued
NDI - Transmittal Form Form and Instruction Modified Available
NDI - Repeat Request Form Form and Instruction Modified Available
Att H NDI Advisory Board Members.docx Supplementary Document Uploaded 2020-01-24 Repair queued
Att G IRB.pdf Supplementary Document Uploaded 2020-01-24 Repair queued
Att B1 60-day FRN.pdf Supplementary Document Uploaded 2020-01-24 Available
Att A Authorizing Legislation.docx Supplementary Document Uploaded 2020-01-24 Available
NDI Sup St B_01152020.docx Supporting Statement B Uploaded 2020-01-24 Repair queued
NDI Sup St A_01152020.docx Supporting Statement A Uploaded 2020-01-24 Available
IC Document Collections
IC IDCollectionTypeStatusForm
6683 NDI - Application Form (paper) Form and Instruction Modified
239473 NDI - Early Release Fee Worksheet Form and Instruction New
239467 NDI - Fee Worksheet Form and Instruction New
239464 NDI Early Relase Transmittal Form Form and Instruction New
239461 NDI - Application Form (electronic) Form and Instruction New
182824 NDI - Transmittal Form Form and Instruction Modified
182823 NDI - Repeat Request Form Form and Instruction Modified
ICR Details
0920-0215 201912-0920-014
Active 201903-0920-004
HHS/CDC 20486
Application Form and Related Forms for the Operation of the National Death Index
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 03/06/2020
Retrieve Notice of Action (NOA) 01/31/2020
  Inventory as of this Action Requested Previously Approved
03/31/2023 36 Months From Approved
1,730 0 0
787 0 0
32,460 0 0
This is a reinstatement with change request for a three-year clearance to use of the administrative forms (the application form, repeat request form, and transmittal form) and the fee worksheets utilized in the operation of the National Death Index (NDI) program.
US Code: 42 USC 306 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  84 FR 54147 10/09/2019
85 FR 5663 01/31/2020
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 1,730 0 0 1,430 10 290
Annual Time Burden (Hours) 787 0 0 300 30 457
Annual Cost Burden (Dollars) 32,460 0 0 31,223 1,237 0
Yes
Miscellaneous Actions
Yes
Using Information Technology
The paper version of the Application Form is still available as an option, but fewer respondents are expected to use the form (3 hours per response). A more efficient electronic version of the Application Form is available at decreased burden per response (2.5 hours per response). Overall ICR burden will increase due to anticipated increases in the number of Application forms, Repeat Request forms, and Transmittal forms, and inclusion of the Fee Worksheet and the Early Release Fee Worksheet.
$133,000
No
    Yes
    No
No
No
No
Uncollected
Renita Macaluso 770 488-6458 [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.
01/31/2020