Data Abstraction Second Funding Support

[NCCDPHP] Maternal Mortality Review Information Application (MMRIA)

Documents and Forms

Document Name Document Type
Data Abstraction Second Funding Support 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 Second Funding Support	Agency IC Tracking Number:	0920-1294

Is this a Common Form? No		IC Status: New

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: 19	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
Annual Number of Responses for this IC	798	798
Annual IC Time Burden (Hours)	11,172	11,172
Annual IC Cost Burden (Dollars)	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.