NCHS: National Vital Statistics Report Forms

Forms and Documents

Document Name	Status
Form 1 National Vital Statistics Report Forms -- line 1 -- Monthly Vital Statistics Report Form	Modified
Form 2 National Vital Statistics Report Form -- line 2-- Annual Vital Statistics Occurence Report Form	Modified
NVSR 2012-15 Supp St B 120111.doc Supporting Statement B	2012-02-23
NVSR 2012-2015 Att f IRB letter[1].doc Supplementary Document	2012-02-23
NVSReport Att A LegisAuth.pdf Supplementary Document	2012-02-23
NVSR 2012-15 Supp St A rev. 020712.doc Supporting Statement A	2012-02-23

IC Document Collections

IC ID	Document Title	Status
6670	National Vital Statistics Report Forms -- line 1 -- Monthly Vital Statistics Report Form	Modified
188714	National Vital Statistics Report Form -- line 2-- Annual Vital Statistics Occurence Report Form	Modified

ICR Details

OMB Control No: 0920-0213	ICR Reference No: 201202-0920-009
Status: Historical Active	Previous ICR Reference No: 200904-0920-007
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: NCHS: National Vital Statistics Report Forms
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/02/2012
	Date Received in OIRA: 02/29/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2015	36 Months From Approved	04/30/2012
Responses	1,150	0	1,150
Time Burden (Hours)	211	0	211
Cost Burden (Dollars)	0	0	0

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Abstract: This Project is the collection of monthly and annual counts of Vital Statistics data from states (and in some instances other jurisdictions). These data are widely used by the health and behavioral science communities in surveillance and in tracking trends, by the private sector, and by academia for health and demographic research. State and national data are required by the Census Bureau to prepare annual population estimates and projections.

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Authorizing Statute(s): US Code: 42 USC 242k Name of Law: Public Health Service
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 61362	10/04/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 10749	02/23/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
National Vital Statistics Report Forms -- line 1 -- Monthly Vital Statistics Report	1	Monthly Vital Statistics Report
National Vital Statistics Report Form -- line 2-- Annual Vital Statistics Occurence Report	2	Annual Vital Statistics Occurence Report

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ICR Summary of Burden

	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	1,150	1,150	0	0	0	0
Annual Time Burden (Hours)	211	211	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $202,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/29/2012

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