View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 0920-0215	ICR Reference No: 201912-0920-014
Status: Historical Active	Previous ICR Reference No: 201903-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 20486
Title: Application Form and Related Forms for the Operation of the National Death Index
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/06/2020
	Date Received in OIRA: 01/31/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2023	36 Months From Approved
Responses	1,730	0	0
Time Burden (Hours)	787	0	0
Cost Burden (Dollars)	32,460	0	0

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,730	1,430	10	290
Annual Time Burden (Hours)	787	300	30	457
Annual Cost Burden (Dollars)	32,460	31,223	1,237	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: The paper version of the Application Form is still available as an option, but fewer respondents are expected to use the form (3 hours per response). A more efficient electronic version of the Application Form is available at decreased burden per response (2.5 hours per response). Overall ICR burden will increase due to anticipated increases in the number of Application forms, Repeat Request forms, and Transmittal forms, and inclusion of the Fee Worksheet and the Early Release Fee Worksheet.

Annual Cost to Federal Government: $133,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. 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

Agency Contact: Renita Macaluso 770 488-6458 arp5@cdc.gov

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