Data Abstraction

[NCCDPHP] Maternal Mortality Review Information Application (MMRIA)

Documents and Forms

Document Name Document Type
Data Abstraction Form and Instruction
Data Abstraction Attachment 3a. MMRIA_abstraction_forms.pdf Form and Instruction
Data Abstraction Attachment 3a. MMRIA_abstraction_forms.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Data Abstraction	Agency IC Tracking Number:	0920-1284

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	Data Abstraction	Attachment 3a. MMRIA_abstraction_forms.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Vital Statistics for Births, Deaths, Fetal Deaths, Marriages and Divorces Occurring in the United States During Each Year	FR Citation: 49 FR 37695

Number of Respondents: 34	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,428	678	750
Annual IC Time Burden (Hours)	21,420	10,170	11,250
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.