View Information Collection (IC)

View Information Collection (IC)

IC Title:	Monthly Vital Statistics Report	Agency IC Tracking Number:	0920-0213

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	0920-0213	Annual Vital Statistics Occurance Report	Att C Monthly Form 5202020.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 91	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	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	91	0	-605	0	0	696
Annual IC Time Burden (Hours)	46	0	-47	0	0	93
Annual IC Cost Burden (Dollars)	300	0	-1,997	0	0	2,297

Documents for IC

Title	Document	Date Uploaded
Example of Email Request	Attachment E - Example Email Request.docx	05/13/2022

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