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NDI - Fee Worksheet
[NCHS] Application Form and Related Forms for the Operation of the National Death Index
OMB: 0920-0215
IC ID: 239467
OMB.report
HHS/CDC
OMB 0920-0215
ICR 202301-0920-012
IC 239467
( )
Documents and Forms
Document Name
Document Type
NDI - Fee Worksheet
Form and Instruction
NDI Fee Worksheet
Att E1 NDI FEE WORKSHEET(2020).xls
Form and Instruction
NDI Fee Worksheet
Att E1 NDI FEE WORKSHEET(2020).xls
Form and Instruction
Cover Page E1.docx
OMB Control Header and Burden Statement
IC Document
Cover Page E1.docx
OMB Control Header and Burden Statement
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
NDI - Fee Worksheet
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
n/a
NDI Fee Worksheet
Att E1 NDI FEE WORKSHEET(2020).xls
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Vital Statistics for Births, Deaths, Marriages and Divorces Occurring in the United States Each Year 09-20-0166
FR Citation:
49 FR 37695
Number of Respondents:
450
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
90 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
450
0
234
0
0
216
Annual IC Time Burden (Hours)
113
0
59
0
0
54
Annual IC Cost Burden (Dollars)
0
0
-2,226
0
0
2,226
Documents for IC
Title
Document
Date Uploaded
OMB Control Header and Burden Statement
Cover Page E1.docx
02/08/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.